![]() Biomarker and gene expression profiles are now routinely used to predict prognosis and response to therapy. With improved understanding of tumor biology, medical decision-making is increasingly dependent on molecular profiling of the primary tumor. Greater nodal involvement is associated with a worse prognosis, suggesting that more extensive surgery, radiation, and systemic therapy may be beneficial. In the AJCC TNM staging schema, metastatic disease in 1–3, 4–9, and ≥10 axillary lymph nodes constitutes N1, N2, and N3 diseases, respectively. 7 Clinical staging integrates physical examination and imaging findings, while pathological staging incorporates the results of surgical pathology. Anatomic staging of breast cancer includes both clinical and pathological staging. The presence of axillary lymph node metastases has historically been considered an important prognostic factor in breast cancer, and impacted many aspects of medical decision making. Both of these roles have been called into question, leading to an ongoing reevaluation of the necessity of axillary surgery. Second, it is a potential therapy for management of disease in the axilla. First, it provides anatomic staging information which is used to predict prognosis and inform medical decision making related to adjuvant therapy. Here, we review evolving paradigms for staging of the axilla in breast cancer, with a particular emphasis on the current and future role of axillary ultrasound.Īxillary surgery has two potential roles in breast cancer management. Axillary ultrasound (AUS) has been proposed as a non-invasive and cost-effective alternative to SLNB for staging the axilla in breast cancer. 5, 6 Recent advances in axillary imaging and molecular profiling of primary breast cancers have called into question the necessity of SLNB/axillary surgery. Sentinel lymph node mapping made possible sentinel lymph node biopsy (SLNB) for early-stage breast cancers, sparing patients the morbidity of axillary lymph node dissection (ALND). Breast conserving surgery further decreased the invasiveness of breast cancer surgery. 4 The modified radical mastectomy replaced the radical mastectomy. 3 In the century since Halsted pioneered the radical mastectomy, advances in diagnostic imaging, systemic therapy, radiation therapy and an improved understanding of breast cancer biology have led to a dramatic de-escalation of breast cancer surgery. 2 This led William Halsted to propose radical mastectomy (excision of the breast tissue, pectoralis muscle, and ipsilateral axillary lymph nodes) for the treatment of breast cancer. In the 19th century, Rudolph Virchow postulated that axillary lymph node metastases facilitated the distant metastatic spread of breast cancer. 1 Axillary surgery has long been central to the staging and treatment of breast cancer. In 2021, it is estimated that 280,000 cases of breast cancer will be diagnosed in the US, resulting in over 43,000 deaths. Introduction to Staging of the Axilla in Breast Cancerīreast cancer is the most prevalent cancer in women, and the second-leading cause of cancer death. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy. Staging of the axilla has undergone a dramatic de-escalation however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. This paradigm has now been called into question. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |