Management of regional nodal disease for invasive breast cancer used to be very simple. All patients were recommended an axillary node dissection as it was considered therapeutic, it was prognostic and guided recommendations for adjuvant therapy, and contributed to locoregional control.
Developments in imaging and early diagnosis, surgical techniques, radiation and medical oncology, and understanding of tumour biology have challenged this simple algorithm. Trials have suggested that less extensive surgery leads to equivalent outcomes, while others suggest that more extensive radiotherapy may have advantages.
The most common clinical question facing the breast surgeon is whether to recommend further axillary treatment for a patient with limited disease in the sentinel node. A further question is whether to recommend any axillary surgery in certain low risk patients. These are subjects of current surgical trials that will be reviewed in this presentation.