Breast Cancer: Targets and Therapy (May 2021)
Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound
Abstract
Michael Y Chen,1 William E Gillanders1,2 1Department of Surgery, Washington University, St Louis, MS, USA; 2Siteman Cancer Center in St. Louis, St Louis, MS, USACorrespondence: William E GillandersSiteman Cancer Center in St. Louis, 660 South Euclid Avenue Campus Box 8109, St Louis, MS, 63110, USATel +1 314 747 0072Email [email protected]: Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.Keywords: breast cancer, axillary staging, SLNB, ALND, axillary ultrasound, Z0011
