This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endocrinology and breast, Subject name: Surgery
The most impoant prognostic factor in carcinoma breast is 
Select and explain. 
A. Size of tumour, B. Skin involvement, C. Involvement of muscles, D. Axillary gland involvement
D: Axillary gland involvement
Answer: D: Axillary gland involvement 
Explanation: The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.Size of lesion is least impoant.The extent of axillary lymph node involvement by breast cancer--is the most established and reliable prognostic factor for subsequent metastatic disease and survivalDevita principles of oncology 10th edition, Bailey and love 26th edition.