Axillary staging during surgery for breast cancer

Background: Axillary lymph node status remains the single most important prognostic parameter in patients with breast cancer. In approximately half of operations sentinel lymph node biopsy cannot be employed and axillary dissection is indicated. Retrieval of ten nodes has hitherto been considered sufficient, but it remains questionable whether the removal of more lymph nodes might improve staging. Methods: Data from 31679 breast cancer operations in Denmark were analysed. Results: The number of axillary lymph nodes retrieved was an independent and strong predictor of node positivity. The more lymph nodes retrieved, the better the staging of the disease; this was evident for all sizes of tumour. Dissection of 20 or more nodes rather than ten to 14 increased the probability of node positivity from 14.2 to 25.9 per cent for 1-5-mm tumours, from 38.6 to 47.9 per cent for 11-20-mm tumours, and from 80.6 to 90.0 per cent for tumours with diameter greater than 50 nun. Conclusion: The number of metastatic lymph nodes increased as more nodes were retrieved. These findings underline the need for high-quality specialist surgical and pathological services in breast cancer treatment.