Abstract
The optimal method for staging the axilla in breast cancer patients remains controversial despite the advent of sentinel node biopsy. Until recently, axillary lymph node dissection (ALND) was the standard form of axillary surgery and provided information on prognosis together with loco-regional control of disease. Breast cancer is now recognized as a heterogeneous disease with a variable and often unpredictable natural history and patterns of dissemination which have implications for surgical therapies. This article reviews the principles of axillary management and considers whether a more flexible and selective strategy is appropriate in the current era of shifting paradigms and stage of disease at presentation. Initial staging procedures for the axilla might incorporate a range of surgical options including sampling, sentinel node biopsy and ALND. The choice of surgery and ‘standard of care’ will be determined by individual patient and tumor characteristics, thus reflecting a tailored approach to axillary management.