There have been more controversies about the management ofthe axilla during the past three

years than ever in the past. Management of the axilla in breast cancer patients has evolved from routine axi llary lymph node dissection (ALND) for all patients to a highly selective approa ch based on the assessment of the sentinel lymph nodes (SLNs) as well as tumor and patient characteristics. Although ALND continues to have an important rol e in staging and regional control for many breast cancer patients, recent trial res ults question the need for routine ALND in patients who have positive SLNs. A pproximately 40 percent of patients with a positive sentinel lymph node (SLN)will be found to have residual disease in the axilla