Following the data: past, present, and future management of the axilla in breast cancer patients.

Validation of sentinel lymph node (SLN) dissection (SLND) as an alternative to axillary lymph node dissection (ALND) has been a significant advance in the surgical management of breast cancer. As detailed in the review by Pilewskie and Morrow,[1] clinical trials have proven that in clinically node-negative patients, SLND provides accurate staging with less morbidity, and that ALND can be omitted in patients with negative SLNs without diminishing disease-free survival, overall survival, or local-regional control.[2-4] Moreover, in patients with micrometastases,[5,6] and in select patients with SLN macrometastases, use of ALND has not improved local-regional control or survival.[7,8] One constant finding in these trials is low axillary recurrence rates—consistently less than 3%.