Axillary Sampling, a procedure aimed at assessing the lymph nodes in the armpit region, plays a pivotal role in determining the extent of disease spread in breast cancer and guiding treatment decisions.

Why is Axillary Sampling Done?

Axillary sampling is performed primarily to evaluate the status of the axillary lymph nodes in patients diagnosed with breast cancer. The presence or absence of cancer cells in these lymph nodes serves as a crucial prognostic indicator, influencing treatment planning and predicting the likelihood of disease recurrence. By sampling a subset of lymph nodes from the axilla, surgeons can assess whether cancer cells have spread beyond the primary tumor site, aiding in disease staging and determining the most appropriate course of action.

Procedure:

The procedure of axillary sampling typically takes place concurrently with primary breast surgery, such as lumpectomy or mastectomy. It involves the surgical removal of a few sentinel lymph nodes or a small portion of the axillary nodal tissue for histopathological examination. Here's a simplified overview of the steps involved:

• Preoperative Evaluation: Prior to surgery, patients undergo imaging studies, such as ultrasound or PETCT, to assess the extent of lymph node involvement and guide surgical planning.

• Anesthesia: The patient receives general anesthesia to ensure comfort and immobility throughout the procedure.

• Incision: A small incision is made in the axillary region, usually in proximity to the primary breast tumor site.

• Lymph Node Identification: Using an anatomical template, the area containing the firstgroup of lymph nodes which are likely to receive drainage from the breast, are identified.

• Node Removal: The select portion of the axillary tissue including lymph nodes is carefully dissected and excised.

• Histopathological Analysis: The excised tissue with lymph nodes is sent to the pathologist for detailed examination under a microscope to detect the presence of cancer cells.

• Pathological Examination: In most cases, frozen section evaluation of the nodes is performed under a microscope to determine whether cancer cells are present. This technique has a fairly high accuracy and takes a few minutes only. The result helps to guide the further intraoperative plan.

• Additional Lymph Node Evaluation (if necessary): In cases where the nodes are found to contain cancer cells, additional lymph nodes in the axilla (armpit) may be removed for further clearance.

• Closure: A drain tube is usually placed to prevent fluid accumulation. The incision site is closed with sutures and appropriate dressings are applied.

Benefits of Axillary Sampling:

• Accurate Staging: Axillary sampling provides valuable information about the extent of lymph node involvement, aiding in accurate staging of the disease. This helps to guide the extent of axillary surgery intraoperatively and determine the appropriate treatment strategy postoperatively.

• Tailored Treatment Planning to Reduce Morbidity: By identifying patients with lymph node metastasis, axillary sampling enables personalized treatment planning. Patients with node-negative disease may be spared unnecessary axillary lymph node dissection, thereby reducing the risk of complications such as lymphedema and shoulder dysfunction.

• Prognostic Information: The presence of cancer cells in the axillary lymph nodes is associated with an increased risk of disease recurrence. Axillary sampling helps stratify patients based on their risk profile, allowing for more informed discussions regarding prognosis and follow-up care.

• Minimally Invasive Approach: Compared to traditional axillary lymph node dissection, which involves the removal of a larger number of nodes, axillary sampling is a less invasive procedure associated with reduced morbidity and shorter recovery times.

Axillary sampling is a critical component of breast cancer management, providing essential information about lymph node status and facilitating personalized treatment strategies. Through this minimally invasive procedure, our breast oncoplastic surgeon will optimize the patient outcomes while minimizing the potential for treatment-related complications.