J.Jpn. Surg. Soc.. 117(6): 509-515, 2016

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Feature topic

SENTINEL LYMPH NODE BIOPSY AND AXILLARY DISSECTION

Dr. William Stewart Halsted first advocated performing total mastectomy with pectoral muscle resection and axillary lymph node dissection as the standard surgery for breast cancer. The effectiveness of the sentinel lymph node biopsy was confirmed 100 years later. When a sentinel lymph node biopsy shows no cancer cells in the lymph node, the standard method is to omit axillary dissection. In recent years, there have been some reports of the validity of omitting axillary dissection when sentinel lymph node biopsy is positive for metastasis. When micrometastasis is present in sentinel lymph nodes, it is reasonable to omit axillary dissection. However, when macrometastasis is present, it is necessary to determine whether axillary dissection should be omitted by referring to the inclusion criteria of the Z0011 study. Complications of axillary lymph node dissection may include upper arm edema, glenohumeral joint excursion obstacles, and neuropathy. Early rehabilitation regimens can maintain glenohumeral joint excursion. Good sanitation including the nails, the use of moisturizers, and early administration of antiinflammatory agents for injuries can prevent lymphedema. If lymphedema develops, the wearing of an elastic bandage or sleeve, manual lymph drainage, and kinesiology exercises with a qualified instructor are effective.

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