The time has come to change the algorithm for the surgical management of early XXXX .

@entity1 @entity1137 @entity0 @entity5 @entity1711 @entity513 @entity1710 @entity3
HYPOTHESIS: If the sentinel lymph nodes (SNs) draining a primary @entity0 are free of @entity5 , then axillary lymph node dissection is not necessary for management of disease. DESIGN AND INTERVENTION: In July 2000, we reported our initial experience of a small cohort of @entity1 who underwent axillary lymph node dissection only if their SNs were involved with @entity3 . We now report outcome data for all @entity1 who underwent breast conservation and sentinel lymph node dissection without completion axillary lymph node dissection between October 1, 1995, and April 30, 1999. SETTING: Tertiary breast referral center. @entity1 : Two hundred thirty-eight @entity1 whose SN staining results were negative for @entity5 by both @entity1710 - @entity1711 and imunohistochemical stains. Median age was 58.4 years. Most @entity1 (85%) had a T1 @entity5 ; 15% had a T2 @entity5 . Most (86%) had infiltrating @entity513 with or without extensive @entity513 in situ; 10% had @entity1137 . RESULTS: At a median follow-up of 38.9 months (range, 6-69 months), we found no axillary recurrences, and 98.3% of @entity1 are alive without evidence of disease. Three @entity1 have died of causes not related to @entity0 . Four @entity1 are alive with metastatic disease but have not developed axillary recurrences. CONCLUSIONS: Sentinel lymph node dissection is a safe and efficacious treatment option for @entity1 with early @entity0 . It provides excellent regional control and is associated with excellent survival. A multicenter trial such as the American College of Surgeons Oncology Group Z0010 is needed to corroborate findings of this single-institution study.
