الفهرس 
introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Management of the axilla in the breast cancer patient has been a subject of intense debate and controversy. Despite a tendency toward a conservative approach for the surgery of primary breast carcinoma, axillary lymph node dissection (ALND) his remained an integral part of breast cancer management for more than a century. This because axillary lymph node status is still considered the single most important prognostic indicator in breast cancer patients. Lack of imaging techniques or minimally invasive procedure to determine axillary lymph node status with acceptable accuracy has been the main reason for continuing to perform ALND. It is ironic that the extent, morbidity, and the cost of the staging procedure (ALND) is greater than the surgical treatment of the primary tumor. Epidemiologic studies indicate that breast cancer are smaller at presentation and have less likelihood of lymph node involvement than the past. This could be as a result of wide spread use of mammographic screen and increased patients general awareness. Up to 70% of patients with T1&T2 tumors have a negative maxillary dissection and more than 50% of these node negative patients develop a morbidity related to ALND. We should not compel our patients to endure the expensive and morbidity of procedure only to satisfy the rigidities of current staging requirements if it does not directly or indirectly improve the length or quality of life.