engleski

Surgical treatment for breast cancer and axillary metastases: Historical perspective.

Breast cancer (BC) is the most common malignancy to affect women. It is estimated that one in eight women is diagnosed with BC at some point in her life. Both morbidity and mortality increase with age, so 80% of the cases occur in women aged 50 or older. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. In 1894, William Stewart Halsted introduced his surgical technique, radical (Halsted) mastectomy, which included the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite associated comorbidities, such as disabling lymphedema and weakened arm function, the radical mastectomy was the primary surgical approach to BC patients until 1948, when Patey and Dyson introduced the modified radical mastectomy. The latter spared pectoralis major and minor and the level III of axillary lymph nodes, which reduced the risk of postoperative complications and improved quality of life. Umberto Veronesi represented the idea of breast- conserving surgery in the 1970s, which led to further minimizations of breast surgery. Since the sentinel lymph node (SLN) biopsy (SLNB) was introduced in the 1990s, many women with negative SLNs and with SLNs containing micrometastases (0.2-2 mm in size) have been spared axillary lymph node dissection (ALND). The omission of ALND in the last decade also included BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy was included in the treatment. In conclusion, from extensive surgical procedures as a historical mainstay of BC treatment, including radical mastectomy and ALND, surgical approach to BC patients has turned towards less invasive treatment options. As a result, for most patients with early-stage disease, breast-conserving surgery has become the standard of care, while many women have been spared ALND since SLNB became the gold standard for axillary staging.

breast cancer ; breast surgery ; axillary lymph node metastasis, sentinel lymph node, history.

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