الفهرس 
Anatomy of The BreastOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
A
xillary lymph node dissection (ALND) has been an integral part of the surgical treatment of breast cancer since the popularization of the radical mastectomy by William Halsted in 1894. It was suggested that breast cancer first spreads locoregionally via lymphatics to the axillary lymph nodes and then metastasizes more distantly.
A tailored surgical approach with careful assessment of risks and benefits, together with patient preference, is guiding the evolving modern management of the axilla (high accuracy and low morbidity) for women with early breast cancer.
The role of ALND in survival of breast cancer patients has been a subject of debate. The status of the axillary nodes has long been considered to be the strongest prognostic factor in breast cancer and one of the most important determinants in the decision to use adjuvant systemic chemotherapy. However, as further understanding of breast tumor biology has been gained, the recommendation for adjuvant systemic therapy has shifted from nodal status as the major factor to other indicators of outcome such as tumor size, grade, receptor status, and breast cancer subtype.
Acceptance of the SLN procedure as a standard approach in surgical management raises the question of whether complete ALND is necessary in all patients with positive SLN. It has been shown that SLN is the only positive lymph node in 38-67 % of patients when ALND followed. This finding not only provides strong support for the SLN concept, but also suggests that unnecessary ALND can be avoided in patients with T1 tumor, because removal of negative lymph nodes does not provide any significant benefit.
BCS includes several techniques such as lumpectomy, quadrantectomy, and other oncoplastic techniques. BCS is preferred to be combined with axillary sampling, SLNB and limited axillary lymph node dissection with frozen which is our study (dissection of level 1 axillary lymph nodes with frozen).
The American College of Surgeons Oncology Group Z0011 trial results provided convincing evidence that completion axillary lymph node dissection (CALND) was unnecessary in patients with 1 to 2 macrometastatic sentinel lymph nodes (SLNs). We hypothesized in our study that dissection of level 1 lymph nodes with frozen sufficient to detect status of the axilla to preclude the need for complete axillary dissection or axillary radiotherapy and in the same time avoid the complications of complete axillary dissection with its all subsequent morbidity such as lymphedema, pain, seroma, parasthesia and range of motion.