Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre

Aims Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla. Methods Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery. Results A median of eight nodes was identified (range 0–30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified. Conclusions We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.