Lymph nodes in the tail of the breast can be missed in standard axillary dissection

Abstract 

Aims

To determine whether excision of the tail of the breast usually by mastectomy or occasionally wide excision together with formal level 1 axillary node dissection (AND) for early breast cancer influences the quantity of harvested lymph nodes and the detection of axillary metastases.

Methods

Multiple regression and binary logistic regression analysis were performed on lymph node harvest data for level 1 AND performed prior to the adoption of sentinel node biopsy during a five year period from 1997 to 2001 at the Leicestershire Breast Unit, comparing AND with and without excision of the tail of the breast.

Results

One thousand six hundred and forty-eight level 1 ANDs were performed with a median node harvest of 14 (3–44). Multiple regression analysis identified that the total node harvest was increased by 1.03 nodes if the tail of the breast was excised (p<0.001) and this was independent of the effect on node count of node positivity. Operating surgeon and reporting pathologist did not influence node count.

Conclusions

The results of this study indicate that low axillary nodes may be missed by AND without excision of the tail of the breast and support the use of targeted sentinel node biopsy that should identify an involved node at any site.

Keywords: Breast cancer, Axilla, Lymph nodes, Surgery