Undissected Axilla and Axillary Radiotherapy

To the Editor We read with interest the study of surgeon attitudes toward the omission of axillary lymph node dissection (ALND) in early breast cancer.¹ A previous survey of 849 members of the American Society of Breast Surgeons suggested that “respondents have embraced [the ACOSOG] Z0011 [trial] and omit ALND in patients with 1 or 2 positive nodes.”² In contrast, we now learn that only higher-volume breast cancer surgeons with multidisciplinary interactions are less likely to propose ALND for patients with limited disease in the sentinel node, whereas low-volume surgeons should be targeted for remedial education.¹