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By Melody A. Cobleigh M.D. (auth.), William J. Gradishar M.D., William C. Wood M.D. (eds.)

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Superficial, subcutaneous blue lymphatics can be transected; these should not be confused with lymphatics that drain to the sentinel node and are located deep to the clavi-pectoral fascia. The clavi-pectoral fascia is incised to search for a blue lymphatic channel, which is followed both superiorly and inferiorly. Abducting and flexing the arm helps to bring the axillary contents closer to the incision. Fine forceps are can be used to trace the blue lymphatic to a blue lymph node, representing the sentinel node.

FACTORS INFLUENCING LOCAL-REGIONAL FAILURE RATES FOLLOWING MASTECTOMY There is marked variability in the reported rates of LRF in patients treated with mastectomy and systemic therapy. 11 One reason for the variability may be the use of different systems for scoring events, varying lengths of follow-up, differing tumor-related characteristics of 42 Postmastectomy Radiotherapy the study populations, and substantial variability in treatment techniques (both systemic and surgical). For example, some investigators do not score patients who present with such sites of disease with simultaneous evidence of distant relapse.

Regional node failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 9:988-996, 1991. 4. Cady B, Stone MD, Schuler JG, et al. The new era in breast cancer: invasion, size, and nodal involvement dramatically decreasing as a result of mammographic screening. Arch Surg 131 :301-308, 1996. 5. Keramopoulos A, Tsionou C, Minaretzis D, et al. Arm morbidity following treatment of breast cancer with total axillary dissection: A multivariated approach. Oncology 50:445-449, 1993.

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