الفهرس 
Anatomy of the AxillaOnly 14 pages are availabe for public view
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Abstract
B
reast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women.
The presence or absence of axillary metastases is still the single most powerful predictor of outcome. Axillary lymph node dissection has long been the standard surgical procedure as part of treatment for invasive breast cancer. There is a definitive correlation between the number of nodes excised and the severity of postoperative discomfort.
Currently, about 30-40% of patients have axillary node involvement at diagnosis therefore; these patients are over treated by undergoing axillary node dissection. In the remaining 60-70% of patients, the lymph nodes are not involved by cancer.
Until recently, axillary lymph node dissection has been the standard procedure for axillary staging, often resulting in significant morbidity such as pain, restriction of arm movement or chronic lymphedema.
Recent data suggest that less radical procedures may result in adequate axillary staging and regional control. Total axillary evacuation which is adequate for staging purposes is accompanied by the highest incidence of morbidity, while the least surgical procedure in the form of axillary sampling which carries less morbidity.
A promising alternative is the sentinel node biopsy, which appears to offer a solution to this dilemma. If the concept is valid, it will provide an accurate method of detecting the presence of nodal metastases without performing blind, elective regional lymph node dissection. Unnecessary lymphadenectomy may then justifiably be avoided.
Sentinel node biopsy has been developed during recent years to stage the axilla. The status of the sentinel node predicts the status of the rest of the nodes in the node basin. Three different methods have been used to identify the sentinel node in patients with breast cancer: blue dye, lymphoscintigraphy and intraoperative use of a probe and a combination of these threemethods.
Sentinel lymph node biopsy is a minimally invasive procedure with significantly lower morbidity than axillary lymph node dissection.Sentinel lymph node procedures are based on the concept that a breast tumor drains in a defined anatomical way via the lymphatic system to the axillary nodes. So, it appears that sentinel lymph node biopsy is becoming a successful method for predicting the status of the axillary lymph nodes and avoid unnecessary axillary evacuation in cases with negative sentinel lymph node for metastases.
Sentinel lymph node biopsy, as used in early breast cancer, has been well validated in many institutions. It appears to be a safe and effective alternative to axillary lymph node dissection in patients with early breast cancer. However, due to a very low false—negative rate, this procedure is most valuable in those patients with a low risk of axillary involvement, i.e. those with small tumors.
So, Sentinel lymph nodes represents a significant advantage as a minimally invasive procedure, considering that almost 70% of patients will have nodes free of metastatic disease, and, thus, will avoid routine axillary lymphadenectomy
Radiotherapy, adjuvant hormonal therapy and chemo-therapy are complementary to surgery in the treatment of the disease and have a considerable role in the prevention or delay of relapse. It is the responsibility of the surgeon to evaluate each patient’s condition and needs and select the procedure that gives the best result and outcome, best cosmetic results and offer the patient a good quality of life.