AIMS: To test the hypothesis that a correct qualitative assessment of axillary nodal status can be established by examining only a limited number of lymph nodes. METHODS: Slides from 499 pN1 or pN0 axillary dissection specimens relating to symptomatic breast cancer cases operated on at our institution between 1991 and 1996 were reviewed. Nodes were ranked in descending order on the basis of their estimated size and lymphoid or metastatic tissue content. After ranking, all nodes were studied microscopically; 265 axillary clearance specimens were positive. RESULTS: Assessment of the 3-6 largest/firmest nodes can lead to the detection of 93-98% of node positive patients and can give a correct qualitative assessment of axillary node status in 96-99%. CONCLUSIONS: Sampling the 4-6 largest/firmest nodes seems to be a reliable alternative for the staging of symptomatic breast cancer. These results suggest a reconsideration of the generally held view that a minimum of 10 nodes is required for adequate identification of the pN0 category.
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