[Axillary lymph node dissection in clinically node-positive breast cancer].

Many Japanese surgeons think that clinically node-positive breast cancer is already a systemic disease. However, about 60% of surgeons believe that the survival rate increases with axillary lymph node dissection. Furthermore, 64% of surgeons change the area of axillary lymph node dissection based on the intraoperative diagnosis of lymph node metastases. We analyzed axillary lymph node dissection in clinically node-positive breast cancer using evidence-based medicine. We recommend that the level I and II axillary dissection be the preferred procedure and that the removal of level III axillary nodes is not necessary for staging. However, if grossly positive nodes are identified intraoperatively, a level III dissection should be carried out to maximize local control.