Axillary biopsy compared with dissection in the staging of lymph nodes in operable breast cancer. A randomised trial.

OBJECTIVE

To compare the accuracy of axillary dissection with that of axillary node biopsy for staging of lymph nodes in operable breast cancer.

DESIGN

Randomised study.

SETTING

District hospital, Oestersund, Sweden.

SUBJECTS

200 women with operable breast cancer who presented between 1985-87 and 1989-91.

INTERVENTIONS

Women were randomised (n = 100 in each group) to have either axillary dissection (in which all fat tissue was removed from the axilla) or biopsy (in which the lower half of the axillary fat, together with obviously malignant nodes were removed for histopathological examination).

MAIN OUTCOME MEASURES

Number of nodes harvested by each method, and number that contained metastases.

RESULTS

Nodes that contained metastases were found in 43 of the patients in the dissection group and 46 of those who had undergone biopsy alone. The median (range) yield of nodes in the dissection group was 8.5 (0-16) and in the biopsy group 6 (0-14), p < 0.001. In only two patients (one in each group) were no nodes identified. Patients without histologically confirmed node metastases were followed up for a median of 30 months; one in the biopsy group had a metastatic node detected three months after operation. During the last 100 operations the surgeon was asked to assess clinically whether the patients had involved nodes or not; this had a sensitivity of 59% and a specificity of 89%.

CONCLUSION

Axillary node dissection and biopsy give similar results in the staging of breast cancer. Perioperative clinical judgement is unsatisfactory.