الفهرس 
Anatomy of axillaOnly 14 pages are availabe for public view
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Abstract
Breast carcinoma is the commonest malignant tumor in females. In Egypt it accounts for about 25.5% of all females. In Egyptian females the average age incidence is about 44.1 years being more common in nullipara.It constitutes about 29.3% of female cancers and the incidence increase steadily over past 80 years. (1)
Regional lymph node status is one of the most important prognostic factors for disease-free and overall survival in breast cancer. Today, the gold-standard method for staging patients with early-stage breast cancer with clinically negative axillary lymph nodes is the sentinel lymph node biopsy (SLNB) (2).
Anatomically, the axillary region is divided into five subregions: anterior, posterior, lateral, central and apical zones.
A sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. Axillary lymph node dissection has long been the standard procedure for determining the nodal stage in breast cancer.
Complications of axillary dissection, including pain, paresthesias, lymphedema, seroma, infection, and limitation of shoulder motion, can be disabling. Sentinel lymph node biopsy is less invasive than a complete or level ǀ-ǁ axillary dissection and lower both morbidity and cost (3).
The sentinel lymph node accurately reflects the status of the remaining axillary nodes in most cases and suggests that sentinel lymph node biopsy may eventually replace axillary dissection as the nodal staging procedure of choice. Sentinel lymph node biopsy is done by injection of3-5 cm of blue dye in the peritumor area then the injection site is massaged gently for 7-10 min. transverse Incision is done at the axilla and identification of blue stained lymph node which is dissected and sent for histopathology (3).
The sentinel lymph node can be identified by injection of either a radiotracer or a blue dye, or preferably both, into the breast. The aim is to remove any ‗hot‘ or blue nodes for pathological evaluation. During this procedure any other palpable nodes are removed and included as part of the sentinel node biopsy specimen (3).
Morbidity rates are substantially lower with sentinel node dissection compared with axillary dissection. Patients have more rapid return to full mobility and are able to return to work and other activities weeks sooner than after axillary dissection. Long-term morbidity, including lymphedema, numbness, and chronic pain, is greatly reduced. Sentinel node dissection has been shown to provide reliable pathologic staging of the axilla, with false-negative rates generally lower than 5% in experienced hands. Axillary recurrence rates have been shown to be extremely low after a negative sentinel node biopsy without axillary dissection. A negative sentinel node biopsy is now widely accepted as sufficient to establish a patient as node-negative, with no further axillary treatment required (4).
Neo-adjuvant chemotherapy (NACT) is gaining interest as it offers the advantage of down staging the disease and testing the efficacy of therapy administered to patients.
The introduction of the platina derivatives in neoadjuvant trials with theirexceptional high pathological complete response rates are challenging to rethink the optimal treatment options in early and locally advanced breast cancer.