Mayo Clinic Proceedings Home

Comparison of Mastoscopic and Conventional Axillary Lymph Node Dissection in Breast Cancer: Long-term Results From a Randomized, Multicenter Trial

Published:November 12, 2012DOI:



      To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND).

      Patients and Methods

      From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival.


      The mean operative blood loss in the MALND group was less than in the CALND group (P<.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (P<.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (P=.001 at 6 months and P=.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (P=.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (P=.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (P=.95).


      Compared with CALND, MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics.

      Abbreviations and Acronyms:

      ALND (axillary lymph node dissection), CALND (conventional axillary lymph node dissection), MALND (mastoscopic axillary lymph node dissection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Luini A.
        • Gatti G.
        • Ballardini B.
        • et al.
        Development of axillary surgery in breast cancer.
        Ann Oncol. 2005; 16: 259-262
        • Tamaki Y.
        • Tsukamoto F.
        • Miyoshi Y.
        • et al.
        Overview: video-assisted breast surgery.
        Biomed Pharmacother. 2002; 56: 187s-191s
        • Hussien M.
        • Spence R.A.
        Axillary lymph node clearance: overcoming the technical difficulties.
        Breast. 2004; 13: 133-138
        • Chengyu L.
        • Jian Z.
        • Hua L.
        Mastoscopic axillary lymph node dissection for the patients with breast cancer.
        Zhonghua Yi Xue Za Zhi. 2003; 83: 1946-1948
        • Winzer K.J.
        • Ivancevic V.
        • Fischer S.
        • et al.
        Endoscopic sentinel node detection with a gamma probe combined with minimally invasive axillary lymph node dissection: a preliminary study.
        Eur J Surg. 2001; 167: 19-22
        • Carter B.A.
        • Jensen R.A.
        • Simpson J.F.
        • et al.
        Benign transport of breast epithelium to axillary lymph nodes after biopsy.
        Am J Clin Pathol. 2000; 113: 259-265
        • Zoli W.
        • Barzanti F.
        • Dal-Susino M.
        • et al.
        Flow-cytometric determination of tumor cells in lymph nodes.
        Oncology. 2002; 62: 128-135
        • Goss M.
        • D'Amico S.
        • Mobiglia A.
        • et al.
        Surgical approach to cervical lymph node metastasis in differentiated thyroid cancer.
        Tumori. 2002; 88: S47-S48
        • Chengyu L.
        • Yongqiao Z.
        • Hua L.
        • et al.
        A standardized surgical technique for mastoscopic axillary lymph node dissection.
        Surg Laparosc Endosc Percutan Tech. 2005; 15: 153-159
        • Kang S.H.
        • Kim S.K.
        • Kwon Y.
        • et al.
        Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy.
        World J Surg. 2004; 28: 1019-1024
        • Schwartz G.F.
        • Tannebaum J.E.
        • Jernigan A.M.
        • et al.
        Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast.
        Cancer. 2010; 116: 1243-1251
        • Arnaud S.
        • Houvenaeghel G.
        • Moutardier V.
        • et al.
        Patients' and surgeons' perspectives on axillary surgery for breast cancer.
        Eur J Surg Oncol. 2004; 30: 735-743
        • Suzanne F.
        • Emering C.
        • Wattiez A.
        • et al.
        Endoscopic axillary lymphadenectomy after liposuction.
        Surg Technol Int. 1997; 6: 133-138
        • Kuhn T.
        • Santjohanser C.
        • Koretz K.
        • et al.
        Axilloscopy and endoscopic sentinel node detection in breast cancer patients.
        Surg Endosc. 2000; 14: 573-577
        • Brun J.L.
        • Bellennee G.
        • Rousseau E.
        • et al.
        Does axillary liposuction modify histologic study of excised lymph nodes?.
        J Gynecol Obstet Biol Reprod. 1997; 26: 503-506
        • Salvat J.
        • Knopf J.F.
        • Ayoubi J.M.
        • et al.
        Endoscopic exploration and lymph node sampling of the axilla: preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment.
        Eur J Obstet Gynecol Reprod Biol. 1996; 70: 165-173
        • Ho W.S.
        • Ying S.Y.
        • Chan A.C.
        Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer.
        Surg Endosc. 2002; 16: 302-306
        • Brun J.L.
        • Rousseau E.
        • Belleannee G.
        • et al.
        Axillary lymphadenectomy prepared by fat and lymph node suction in breast cancer.
        Eur J Surg Oncol. 1998; 24: 17-20
        • Chengyu L.
        • Jian Z.
        • Xiaoxin J.
        • et al.
        Experience of a large series of mastoscopic axillary lymph node dissection.
        J Surg Oncol. 2008; 98: 89-93
        • De Wilde R.L.
        • Schmidt E.H.
        • Hesseling M.
        • et al.
        Comparison of classic and endoscopic lymphadenectomy for staging breast cancer.
        J Am Assoc Gynecol Laparosc. 2003; 10: 75-79
        • Yamashita K.
        • Shimizu K.
        Endoscopic video-assisted breast surgery: procedures and short-term results.
        J Nippon Med Sch. 2006; 73: 193-202
        • Langer I.
        • Kocher T.
        • Guller U.
        • et al.
        Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients.
        Breast Cancer Res Treat. 2005; 90: 85-91
        • Hussein O.
        • El-Nahhas W.
        • El-Saed A.
        • et al.
        Video-assisted axillary surgery for cancer: non-randomized comparison with conventional techniques.
        Breast. 2007; 16: 513-519
        • Gomatos I.P.
        • Filippakis G.
        • Albanopoulos K.
        • et al.
        Complete endoscopic axillary lymph node dissection without liposuction for breast cancer: initial experience and mid-term outcome.
        Surg Laparosc Endosc Percutan Tech. 2006; 16: 232-236
        • Tagaya N.
        • Kubota K.
        Experience with endoscopic axillary lymphadenectomy using needlescopic instruments in patients with breast cancer: a preliminary report.
        Surg Endosc. 2002; 16: 307-313
        • Malur S.
        • Bechler J.
        • Schneider A.
        Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer.
        Surg Laparosc Endosc Percutan Tech. 2001; 11: 38-41
        • Kamprath S.
        • Bechler J.
        • Kuhne-Heid R.
        • et al.
        Endoscopic axillary lymphadenectomy without prior liposuction: development of a technique and initial experience.
        Surg Endosc. 1999; 13: 1226-1229
        • Haid A.
        • Kuehn T.
        • Konstantiniuk P.
        • et al.
        Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer.
        Eur J Surg Oncol. 2002; 28: 705-710
        • Whelan T.
        • MacKenzie R.
        • Julian J.
        • et al.
        Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer.
        J Natl Cancer Inst. 2002; 94: 1143-1150
        • Tominaga T.
        • Takashima S.
        • Danno M.
        Randomized clinical trial comparing level II and level III axillary node dissection in addition to mastectomy for breast cancer.
        Br J Surg. 2004; 91: 38-43
        • Mansel R.E.
        • Fallowfield L.
        • Kissin M.
        • et al.
        Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.
        J Natl Cancer Inst. 2006; 98: 599-609
        • Husted Madsen A.
        • Haugaard K.
        • Soerensen J.
        • et al.
        Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group.
        Breast. 2008; 17: 138-147
        • Veronesi U.
        • Paganelli G.
        • Viale G.
        • et al.
        A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer.
        N Engl J Med. 2003; 349: 546-553
        • Owaki T.
        • Yoshinaka H.
        • Ehi K.
        • et al.
        Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision.
        Breast. 2005; 14: 57-60
        • Cangiotti L.
        • Poiatti R.
        • Taglietti L.
        • et al.
        A mini-invasive technique for axillary lymphadenectomy in early breast cancer: a study of 15 patients.
        J Exp Clin Cancer Res. 1999; 18: 295-298
        • Lim S.M.
        • Lam F.L.
        Laparoscopic-assisted axillary dissection in breast cancer surgery.
        Am J Surg. 2005; 190: 641-643
        • Yoo W.M.
        • Pae N.S.
        • Lee S.J.
        • et al.
        Endoscopy-assisted ultrasonic surgical aspiration of axillary osmidrosis: a retrospective review of 896 consecutive patients from 1998 to 2004.
        J Plast Reconstr Aesthet Surg. 2006; 59: 978-982
        • Tsangaris T.N.
        • Trad K.
        • Brody F.J.
        • et al.
        Endoscopic axillary exploration and sentinel lymphadenectomy.
        Surg Endosc. 1999; 13: 43-47
        • Suzanne F.
        • Emering C.
        • Wattiez A.
        • et al.
        Le curage axillaire par lipo-aspiration et prelevement endoscopique : a propos de 72 cas.
        Chirurgie. 1997; 122: 138-143
        • Burak Jr, W.E.
        • Goodman P.S.
        • Young D.C.
        • et al.
        Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin.
        J Surg Oncol. 1997; 64: 27-31
        • Dawson I.
        • Stam L.
        • Heslinga J.M.
        • et al.
        Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective clinical trial.
        Br J Surg. 1989; 76: 311-312
        • Harder F.
        • Zuber M.
        • Kocher T.
        • et al.
        Endoscopic surgery to the axilla: a substitute for conventional axillary clearance?.
        Recent Results Cancer Res. 1998; 152: 180-189
        • Meiqin G.
        • Jun J.
        • Xinhua Y.
        • et al.
        Clinical contrast study of histological change of lymph node in mastoscopic axillary lymph node dissection..
        Zhonghua Wai Ke Za Zhi. 2007; 45: 487-488
        • Reynaud P.
        • Abbey-Toby S.
        • Albuisson E.
        • et al.
        Histologic comparison between endoscopic axillary lymphadenectomy after liposuction and classical surgical technique.
        Ann Pathol. 1999; 19: 289-293
        • Weihrauch M.R.
        • Skibowski E.
        • Draube A.
        • et al.
        Immunomagnetic enrichment and detection of isolated tumor cells in bone marrow of patients with epithelial malignancies.
        Clin Exp Metastasis. 2002; 19: 617-621
        • Aponte-Rueda M.E.
        • Saade Cárdenas R.A.
        • Saade Aure M.J.
        Endoscopic axillary dissection: a systematic review of the literature.
        Breast. 2009; 18: 150-158
        • Leff D.R.
        • Vashisht R.
        • Yongue G.
        • et al.
        Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?.
        Breast Cancer Res Treat. 2011; 125: 607-625