Management of axillary disease.

The presence of nodal metastases is the most important prognostic indicator in breast cancer, making accurate assessment of the axillary nodal basin critical to delivering optimal therapy in breast cancer. Clinically node-negative women can be reliably staged in a minimally invasive manner using sentinel lymph node dissection (SLND). In node-negative patients receiving neoadjuvant chemotherapy, SLND can be performed after chemotherapy, allowing for a single surgical procedure and a decreased probability of requiring axillary lymph node dissection (ALND). Clinically node-positive patients are currently recommended to undergo ALND, although these recommendations may change with emerging trial data.