Is there still a role for axillary dissection in breast cancer surgery?

The operative management of breast cancer has followed a natural progression toward less invasive techniques over the past century as chemotherapy, hormonal therapy, and radiation therapy have become more effective and used more frequently. Sentinel lymph node (SLN) biopsy in clinically node-negative patients has replaced axillary lymph node dissection (ALND), resulting in improved staging and decreased morbidity. ALND has remained important for patients with clinically involved lymph nodes or positive SLN; however, new evidence from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has identified a subset of patients with breast cancer who do not benefit from axillary lymphadenectomy following a positive SLN biopsy. These results are practice changing and need to be analyzed within the context of patient selection and multidisciplinary treatment. Herein, we review the emerging data regarding the benefits and indications for axillary lymphadenectomy in the modern era of multidisciplinary breast cancer management.