Axillary lymph node dissection in early-stage invasive XXXX : is it still standard today?

@entity5 @entity1 @entity0 @entity4298
Evaluation of axillary lymph node status by sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND) are an inherent part of @entity0 treatment. Increased understanding of @entity5 biology has changed the prognostic and therapeutic impact of lymph node status. Non-invasive imaging techniques like axillary ultrasound, FDG-PET, or MRI revealed moderate sensitivity and high specificity in evaluation of lymph node status. Therefore, they are not sufficient for lymph node staging. Otherwise, the impact of remaining micrometastases and even macrometastases for prognosis and treatment decisions is overestimated. Considering @entity5 biology, the distinction of axillary metastases in @entity5 cells (ITC, pN0(i+)); micrometastases (pN1mi), and macrometastases (pN1a) is not comprehensible. Increasing data support the thesis that remaining axillary metastases neither increase the axillary recurrence rate nor decrease overall survival. It is doubtful that axillary @entity5 cells are capable to complete the complex multistep metastatic process. If applied, axillary metastases are sensitive to systemic treatment and are targeted by postoperative tangential breast irradiation. Therefore, the controversy about the clinical relevance of @entity5 cell clusters or micrometastases in @entity4298 is a sophisticated but not contemporary discussion. Currently, there is no indication for axillary surgery in elderly @entity1 with favorable @entity5 and clinically @entity5 -free lymph nodes. Nonetheless, a rational and evidence-based approach to the management of clinically and sonographically N0 @entity1 with planned breast-conserving surgery and limited @entity5 size is needed now.
