What is the role of surgery in the treatment of breast cancer?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

See the list below:

  • Primary surgery usually includes either a mastectomy (with or without reconstruction) or lumpectomy with wide excision to cancer-free margins of excision (No tumor at ink for invasive disease, 2mm for DCIS).

  • Patients with invasive disease also receive axillary surgery with sentinel node biopsy (SNB). Axillary dissection may be considered in patients with a positive SNB or positive node identied preoperatively with fine-needle aspiration/core biopsy. 

  • SNB involves identification of ≥1 lymph nodes in the draining lymph node basin by injecting, into the breast, isosulfan blue dye that may be visualized, technetium-labeled sulfur colloid that may be detected by a handheld probe, or both; the success rate in identifying sentinel nodes varies by experience but is usually 90-95% in experienced hands and is associated with a false negative rate ≤5-10%.

  • Although axillary dissection had been the standard of care for patients with a positive SNB, studies have indicated comparable local and systemic control rates without axillary dissection for patients who also receive radiation and systemic chemotherapy. [62, 42]


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