Axillary staging: new approaches and treatment of minimal disease

Axillary staging is necessary since 30 to 40% of patients with curable breast cancer will have metastases in the axilla. Years ago, the most radical method of staging was performed: an axillary clearance. However, in patients with a negative axilla, who make up 60 to 70% of all patients, this lymph node dissection has no additional value. Today, with the sentinel node procedure it is possible to offer patients accurate staging of the axilla without the morbidity of axillary clearance. Discussion has now started about the fact that there are subgroups of patients in which the risk of axillary metastases is so low that axillary staging can be omitted. Furthermore, it is standard practice to perform axillary clearance in patients with positive sentinel lymph nodes. However, studies show that, of patients with a positive sentinel lymph node, 40 to 60% have no additional involved lymph nodes.

The following dilemmas, which are all related to minimal disease, are therefore still open for debate and will be discussed in the presentation: Is a sentinel node procedure necessary when only minimal disease is present in the breast? Is axillary treatment necessary when only minimal disease is present in the node? What is the role of the PET/CT scan in axillary staging in minimal disease? How can we stage the axilla after primary systemic treatment when potentially only still minimal disease is present?