A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

The various pitfalls that exist in using predictive systems for sentinel node-positive breast cancer are described, to give insight into the background and building stones of these systems. The aim of this article was to make clinicians aware of these pitfalls before using them in the clinical decision-making process in individual patients with positive sentinel nodes. Besides these pitfalls, the implications concerning the results of the Z0011 trial as presented by Giuliano et al (Giuliano AE, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: The American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 2010; 252:426-32, discussion 432-3) are addressed, and we point out some important issues for debate, before implementation of the conclusions of that practice-changing trial into daily clinical breast cancer practice.