In early-stage breast cancer, axillary dissection only in patients with positive sentinel lymph nodes achieved an overall 10-year disease-free survival rate of more than 90 percent, the same prognosis as conventional total axillary lymph node dissection. The report, published in the April issue of the Annals of Surgery, showed that the overall survival rate for axillary surgery based on biopsy of anterior lymph nodes was even slightly higher than that of conventional total axillary lymph node dissection (93.5 percent vs. 89.7 percent). Dr. Umberto Veronesi and his colleagues from the European Institute of Oncology in Milan, Italy, randomized 516 breast cancer patients undergoing breast-conserving surgery with a mass less than 2 cm in diameter from 1998 to 1999 in order to understand the overall survival rate after sentinel lymph node biopsy surgery, with the trial group (n=259) undergoing sentinel lymph node biopsy and total axillary lymph node dissection for positive patients only, and the control group (n=259) undergoing total axillary lymph node dissection for positive patients. The control group (n=257) underwent conventional total axillary lymph node dissection. In 2006, the investigators reported one axillary recurrence in a patient with negative anterior lymph nodes who did not have axillary lymph node dissection in the trial group. Now, at 10-year follow-up, 26 adverse events occurred in the control group and 23 in the trial group, with an overall 10-year survival rate of 88.8% vs 89.9% in both groups (88.8% with routine axillary dissection and 89.9% with SNLB-based dissection). The investigators predicted that there would be eight patients with false-negative anterior lymph nodes in the trial group, but only two relapses resulted. The investigators concluded that in patients with early-stage breast cancer, disease-free survival with axillary surgery based on sentinel lymph node biopsy was not different from that of total axillary dissection. This further confirms that the sentinel lymph node biopsy technique is not only as effective as conventional surgery in terms of axillary staging, but also as safe as total axillary dissection.