What are best practices in axillary dissection?

Updated: Mar 11, 2019
  • Author: Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC; Chief Editor: Erik D Schraga, MD  more...
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Best Practices

Patients with advanced disease in the axilla with palpable axillary nodes, if proceeding to surgery, generally do not require cytological/histological confirmation of nodal involvement.

Ultrasound assessment of the axilla in combination with either fine needle aspiration or core biopsy can detect a positive axillary node in a large proportion of node-positive cases. This positive preoperative axillary status allows women to proceed directly to axillary dissection, avoiding sentinel node biopsy.

Patients who preoperatively have no evidence of axillary disease should undergo a sentinel node biopsy and have axillary dissection carried out if the sentinel node is positive. This can be carried out during the index operation if the sentinel node can be analyzed intraoperatively using frozen section, imprint cytology, or molecular-based assays.

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