Five-node biopsy of the axilla: an alternative to axillary dissection of levels I–II in operable breast cancer

Background: Axillary clearance of patients with early breast cancer is accompanied by a high risk of arm morbidity. Less invasive ways to establish the axillary nodal status are therefore of interest, especially in women with low risk of nodal metastases. Methods: Four hundred and fifteen breast cancer patients (clinical stage T0–3N0–1 M0) were operated in the axilla with a five-node biopsy followed in the same operation by a further dissection of levels I–II of the axilla in order to evaluate the accuracy of the five-node node biopsy compared with level I–II dissection. Results: In all patients the sensitivity of the five-node biopsy was 97.3% with a negative predictive value of 98.5% and a negative likelihood ratio of 0.027. Among cases detected by screening (n=204) and those clinically detected (n=197) the sensitivity of the five-node biopsy was 95.8% and 97.9% respectively, with negative predictive values of 98.7% and 98.0% and negative likelihood ratios of 0.042 and 0.021 respectively. Conclusion: Five-node biopsy of the axilla has good accuracy for correctly staging the axilla in both clinically and screening-detected cases. Five-node biopsy is an alternative to axillary clearance and sentinel node biopsy in patients with operable breast cancer.