Research Article| Volume 172, ISSUE 5, P501-505, November 1996

Download started.


The value of axillary dissection in T1a breast cancer

      This paper is only available as a PDF. To read, Please Download here.


      Some authors have stated the undesirability of axillary lymph node dissections for very small breast cancers, because so few of their patients have lymph node metastases (3% for T1a lesions in one series).


      Of 6,308 breast cancer cases reviewed from three large urban hospitals 3,077 single primary cases with both axillary dissection and accurate tumor measurements were statistically analyzed.


      For T1a lesions we found axillary metastases to be four times higher (12%) than others have reported. For each tumor size there was a statistically significant difference in the percentage of axillary metastases. There was also a statistically significant difference in the breast cancer-specific survival of patients with different tumor sizes (n = 3,077) at the 3-year, 5-year, 7-year, and 10-year periods.


      These results justify axillary node dissections even for very small invasive cancers of the breast, particularly for invasive ductal histology.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Carter CL
        • Allen C
        • Henson DE
        Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.
        Cancer. 1989; 63: 181-187
        • Balch CM
        • Singetary SE
        • Bland KI
        Clinical decision-making in early breast cancer.
        Ann Surg. 1993; 217: 207-225
        • Kinne DW
        Surgical management of stage I and II breast cancer.
        Cancer. 1990; 66 (Suppl): 1373-1377
        • Harris JR
        • Osteen RT
        Patients with early breast cancer benefit from effective axillary treatment.
        Breast Cancer Res Treat. 1985; 5: 17-21
        • Lin PP
        • Allison DC
        • Wainstock J
        • et al.
        Impact of axillary lymph node dissection on the therapy of breast cancer patients.
        J Clin Oncol. 1993; 11: 1536-1544
        • Yang JH
        • Slack NH
        • Nemoto T
        Effect of axillary nodal status on the long-term survival following mastectomy for breast carcinoma: nodal metastases may not always suggest systemic disease.
        J Surg Oncol. 1987; 36: 243-248
        • Silverstein MJ
        • Gierson ED
        • Waisman JR
        • et al.
        Axillary lymph node dissection for T1a breast carcinoma: is it indicated?.
        Cancer. 1994; 73: 664-667
        • Rosen PP
        • Groshen S
        • Saigo PE
        • et al.
        A long-term follow-up study of survival in stage I (T1NOMO) and stage II (T1N1MO) breast carcinoma.
        J Clin Oncol. 1989; 7: 355-366
        • Rosner D
        • Lane WW
        • Penetrante R
        Ductal carcinoma in situ with microinvasion: a curable entity using surgery alone without need for adjuvant therapy.
        Cancer. 1991; 67: 1498-1503
        • Silverstein MJ
        • Gierson ED
        • Waisman JR
        • et al.
        Predicting axillary node positivity in patients with invasive carcinoma of the breast by using a combination of T category and palpability.
        J Am Coll Surg. 1995; 180: 701-704
        • Recht A
        • Houlihan MJ
        Axillary lymph nodes and breast cancer.
        Cancer. 1995; 76: 1491-1512
        • Petrek JA
        • Blackwood MM
        Axillary dissection: current practice and technique.
        Curr Prob Surg. 1995; 32: 257-332
        • Beahrs OH
        • Henson DE
        • Hutter RVP
        • Kennedy BJ
        Definition of TNM, Primary Tumor (T).
        Handbook for Staging of Cancer. 1993; (Part II): 164
        • Ruffin WK
        • Stacey-Clear A
        • Younger J
        • Hoover HC
        Rational for routine axillary dissection in carcinoma of the breast.
        J Am Coll Surg. 1995; 180: 245-251
        • Joensuu H
        • Taikkanen S
        Cured of breast cancer?.
        J Clin Oncol. 1995; 13: 62-69
        • Hellman S
        Natural history of small breast cancers.
        J Clin Oncol. 1994; 12: 2229-2234
        • Wazer DE
        • Erban JK
        • Robert NJ
        • et al.
        Breast conservation in elderly women for clinically negative axillary lymph nodes without axillary dissection.
        Cancer. 1994; 74: 878-883
        • Cady B
        • Stone MD
        • Wayne J
        New therapeutic possibilities in primary invasive breast cancer.
        Ann Surg. 1993; 218: 338-349
        • Kinne DW
        • Petrek JA
        • Osborne MP
        • et al.
        Breast carcinoma in situ.
        Arch Surg. 1989; 124: 33-36
        • Rosner D
        • Lane WW
        • Penetrante R
        Ductal carcinoma in situ with microinvasion.
        Cancer. 1991; 67: 1498-1503
        • Solin LJ
        • Fowble BL
        • Yeh IT
        • et al.
        Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation.
        Int J Radiation Oncology Biol Phys. 1992; 23: 961-968
        • Adair F
        • Berg J
        • Joubert L
        • Robbins GF
        Long-term follow-up of breast cancer patients: the 30-year report.
        Cancer. 1974; 33: 1145-1150
        • Goldhirsch A
        • Wood WC
        • Senn HJ
        • et al.
        Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer.
        J Nat Cancer Inst. 1995; 87: 1441-1445
        • National Institutes of Health Consensus Development Panel
        Consensus statement: treatment of early-stage breast cancer.
        • Giuliano AE
        • Dale PS
        • Turner RR
        • et al.
        Improved axillary staging of breast cancer with sentinel lymphadenectomy.
        Ann Surg. 1995; 222: 394-401