Surgery is considered the primary treatment for breast cancer. Goals include complete resection of the primary tumor, with negative margins to reduce the risk of local recurrences, and pathologic staging of the tumor and axillary lymph nodes to provide necessary prognostic information. Several different types of operations are available. See the image below.
This specimen radiograph shows the wire and the localized speculated mass in situ, with a good excision margin.
Essential update: ASCO updates guidelines on lymph node dissection and biopsy in early stage breast cancer
The American Society of Clinical Oncology (ASCO) has released updated guidelines on the use of lymph node dissection and biopsy for patients with early stage breast cancer. Recommendations include the following [1, 2] :
Women without sentinel lymph node (SLN) metastases should not undergo axillary lymph node dissection (ALND)
In most cases, ALND should not be performed on women with 1-2 metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy
ALND should be offered to women with SLN metastases who will be undergoing mastectomy
SLN biopsy may be offered to women who have operable breast cancer and multicentric tumors, women with ductal carcinoma in situ who will be undergoing mastectomy, women who have had previous breast and/or axillary surgery, and women who have been treated with preoperative/neoadjuvant systemic therapy
SLN biopsy should not be performed on women with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or who are pregnant