Originally, surgery for breast cancer involved removing the pectoral muscles and the regional lymph nodes. This drastic technique was based on Halsted's paradigm of continuous tumour spread via the lymph nodes. In the last century, the amount of surgery has gradually decreased as breast cancer has been recognised as a primary systemic, or partially systemic, disease. Nowadays, breast-conserving therapy is widely used, but axillary lymph node dissection (ALND) and the sentinel technique are still common. Can the patient also be spared such axillary surgery? We have assembled convincing arguments against ALND (and therefore also against the sentinel technique) based on the probability that positive lymph nodes are unlikely to metastasise and that removing them is redundant. At least a discussion of this topic is more than overdue, even if it may be too early to change behaviour.
