Current concepts in the management of the axilla in early breast cancer: proposed standard of practice in Sri Lanka

Despite breast conservation surgery frequently been done for early breast cancers, mastectomy is still considered as the gold standard in surgical management. However, the management of the axilla has been published following many randomized clinical trials and debated at numerous forums and has gradually become less extensive than the radical axillary clearance done in the past. The reasons are multifactorial and could be attributed for the technological advances in surgery, radiology, systemic therapy and specially radiation therapy. Hence, intense attentiveness on the preoperative status of the axilla has become important in the management of early breast cancer at present.
The global recommendation in managing the axilla for early breast cancer is sentinel lymph node dissection. Currently, with the availability of mammography in most provinces in Sri Lanka, more early cancers with clinically node negative axilla are been detected. Unfortunately, the sentinel lymph node dissection been offered for them are limited, mainly due to the absence of insight on the technique. The current recommendations, and techniques to overcome these recommendations with the limited resources in our country are reviewed in this article.