Clinical evaluation of axillar lymph nodes compared to surgical and pathological findings.

Reviewing the axillar lymph node status in 196 consecutive breast cancer patients and comparing clinical assessment to pathological findings, the author found an overall erroneous appraisal of 39% with 45% false negative and 29% false positive cases. In more than 15% of the cases there were skip metastases. In the T1 group, stratification to the greatest diameter of the tumor gave a significant difference (P less than 0.01) between axillar LNI in tumours smaller or equal to 1 cm and those with a diameter between 1 and 2 cm. Lymph node metastases in the interpectoral space is extremely rare (less than 0.5%) and always macroscopic. Axillar lymph nodes were always invaded in T4 tumours. The author warns against clinical studies based upon clinical assessment of the axillar lymph node status. He advocates a complete axillar lymph node dissection in all cases. He suggests that the T1 classification should be restricted to tumours with a diameter smaller or equal to 1 cm.