Axilla Management in Early-Stage Breast Cancer
Objective
Objective
This guideline recommends the best strategies for the management and the best timing and treatment (surgical and radio-therapeutic) of the axilla in early-stage breast cancer.
Axillary lymph node dissection (ALND) is associated with significant morbidity. Even a completion axillary lymph node dissection following a pathologically positive sentinel lymph node by needle biopsy did not confer benefits sufficient to justify the morbidity risk.
A disease-free survival (DFS) advantage from loco-regional nodal irradiation (LRNI) in certain patients has been demonstrated, as has LRNI over whole-breast irradiation (WBI).
A place for neoadjuvant chemotherapy (NAC) is also under current study.
This systematic review and clinical practice guideline uses high-quality current data to propose best practice principles for management of the axilla in breast cancer.
Management
Managemen...
.... Staging...
...¥70 years of age with clinically nod...
...or patients...
...lifying Statements for Staging:The informatio...
...II. Further Axillary Treatm...
Clinicians should NOT recommend ALND for wo...
...d patients (e.g., patients with medially or ce...
...atements for Further Axillary Treatme...
III. Further Axillary Treatment: SLN...
A) No Further Axillary Surgery Beyond...
...received breast conserving surgery....
...o had mastectomy as well as for th...
B) Radiotherapy of the Axilla (LRNI)...
...erapy to the Axilla Compared with Further Su...
...py Compared with No TreatmentIn patients with uni...
...IV. When NAC is Us...
...ially Node-negative Patients...
...nts who are initially clinically node-negati...
...ially Node-positive Patients
...or patients who were initially clinica...
...ho were initially clinically and biopsy...
...ctomy patients who are node-positive on surg...
...NI for the post-mastectomy node-positive co...
...NI after ALND for patients clinically and bi...
...on-making processes should be put in place...
...B Timing: Before or After NACWe recomme...
...ifying Sentinel Nodes...
...versus Dual TracerFor patients having...
...taging versus Standard Guided (Dye/Isotope)...
...ally node-negative patients with early-s...
...patients with clinically palpable (i.e...
...d Staging versus Surgical StagingWe recom...
Figure 1. Management of the Axilla in Early-Stage Breast Cancer
...Management of the Axilla in Early-Stage...