What is axillary lymph node dissection indicated in a modified radical mastectomy?

Updated: Jun 18, 2021
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: Erik D Schraga, MD  more...
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Best Practices

There has been recent national debate over the indication for axillary lymph node dissection. Current indications for a level I or II axillary dissection in patient undergoing a mastectomy include the following:

  • Preoperative diagnosis of positive axillary lymph node metastasis on fine-needle aspiration or core biopsy

  • Prior inadequate axillary lymph node dissection

  • Positive intraoperative sentinel lymph node biopsy

  • Failed mapping for a sentinel lymph node biopsy

  • Clinically suspicious nodes at the time of surgery

  • Neoadjuvant chemotherapy (outside clinical trials)

  • Axillary local recurrence

Patients should be evaluated for an axillary lymph node dissection on a case-by-case basis. Axillary dissection may not benefit patients with favorable tumor characteristics, elderly patients, patients with multiple comorbidities, or patients for whom a full axillary dissection will not influence the recommendation regarding systemic treatment.

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