caa a22 4500 475790936 CHVBK 20180406123710.0 cr unu---uuuuu 170329e20000701xx s 000 0 eng 10.1007/s004239900055 doi (NATIONALLICENCE)springer-10.1007/s004239900055 Lymph-node dissection in breast cancer [Elektronische Daten] [A. Bembenek, P. M. Schlag] Background: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer, with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure, including dissection of level-I and -II and Rotter's nodes, without level-III nodes, providing at least ten lymph nodes for accurate staging information. Discussion: Axillary dissection still offers the most efficient local control in node-positive patients, whereas, in primarily node-negative patients, irradiation seems to be equally effective. In general, lymph-node dissection does not alter overall survival but there is no doubt that surgical therapy still contributes to cure in early-breast-cancer patients and seems to be curative for certain patients with stage-I carcinoma. The lymph node status of the axilla is crucial for the indication of adjuvant therapy in early invasive breast cancer, but an increasing number of clinical node-negative patients could be managed with information based on features of the primary tumor, regardless of the nodal status. The most promising new concept for the selection of node-positive patients, while avoiding unnecessary morbidity of axillary dissection in early-breast-cancer patients, is the sentinel-node concept. The principle is based on the identification of the first ”sentinel” lymph node reached by lymphatic flow. Thus, only proven node-positive patients undergo axillary dissection. Local failure of internal mammary lymph nodes is rarely recognized; however, internal mammary lymph nodes seem to have an underestimated prognostic significance in about 10-20% of axillary node-negative patients. This may lead to the withholding of systemic therapy for patients with early breast cancer. Nevertheless, there is no indication for a routine parasternal dissection today. The sentinel-node concept may also support the selection of diagnostic internal lymph-node biopsy and subsequent adjuvant therapy in cases with no axillary lymph-node metastases but with internal lymph-node metastases. Springer-Verlag, 2000 Key words Breast cancer nationallicence Lymph-node dissection nationallicence Lymph-node status nationallicence Lymphonodectomy nationallicence Sentinel-node biopsy nationallicence Bembenek A. Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Humboldt-University, Lindenberger Weg 80, D-13122 Berlin, Germany Tel.: +49-30-94171400 Fax: +49-30-94171404, Germany aut Schlag P. M. Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Humboldt-University, Lindenberger Weg 80, D-13122 Berlin, Germany Tel.: +49-30-94171400 Fax: +49-30-94171404, Germany aut Langenbeck's Archives of Surgery Springer-Verlag 385/4(2000-07-01), 236-245 1435-2443 385:4<236 2000 385 423 https://doi.org/10.1007/s004239900055 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004239900055 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bembenek A. Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Humboldt-University, Lindenberger Weg 80, D-13122 Berlin, Germany Tel.: +49-30-94171400 Fax: +49-30-94171404, Germany aut NATIONALLICENCE 700 1- Schlag P. M. Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité Humboldt-University, Lindenberger Weg 80, D-13122 Berlin, Germany Tel.: +49-30-94171400 Fax: +49-30-94171404, Germany aut NATIONALLICENCE 773 0- Langenbeck's Archives of Surgery Springer-Verlag 385/4(2000-07-01), 236-245 1435-2443 385:4<236 2000 385 423 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer