Abstract
Most patients with breast cancer initially present with locally resectable disease. Unfortunately, at least half these patients will eventually die of disseminated disease, proving that clinical resectability and cure are far from synonymous terms. Obviously many patients have clinically occult or microscopic metastases at the time of initial surgical intervention. Aside from suggesting the eventual clinical outcome there has been little need for accurate prediction of which patients would eventually have recurrences. With the recent exciting development of effective adjuvant regimens the need for careful and precise patient selection for systemic therapy has become mandatory. While several factors, such as tumor size, tumor location, histologic grade, local lymphatic invasion, and patient weight are of some value, axillary lymph node status has provided the best estimate of tumor recurrence rate, ranging to over 90% if four or more axillary lymph nodes are involved by tumor. Unfortunately, this is an insufficiently accurate guide to which patients have recurrences. Up to one-third of axillary lymph node-negative patients will eventually die of disseminated disease, while only one-half of patients with one node involved with the tumor will succumb to their disease.