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
...anagement
.... Stagin...
...atients ≥70 years of age with clinically node-...
...or patients
...g Statements for Staging:The information acquire...
...rther Axillary Treatment: SLN(-)...
...ians should NOT recommend ALND for women with e...
...d patients (e.g., patients with medially or...
...ualifying Statements for Further Axillary Trea...
...II. Further Axillary Treatment...
...r Axillary Surgery Beyond SLNB Compar...
...received breast conserving surgery. ( EB , H ,...
...patients who had mastectomy as well as fo...
...iotherapy of the Axilla (LRNI) Compa...
...herapy to the Axilla Compared with Further Sur...
...otherapy Compared with No Treatmen...
...When NAC is Used...
...Initially Node-negative Pati...
...e initially clinically node-negative on...
...nitially Node-positive Patien...
...who were initially clinically and biopsy-prov...
...ients who were initially clinically and biop...
...patients who are node-positive on surgical path...
...I for the post-mastectomy node-positi...
...mmend LRNI after ALND for patients clini...
...cision-making processes should be put in place wh...
...SLNB Timing: Before or After NACWe recommend agai...
...entifying Sentinel Nodes...
...Single versus Dual TracerFor patients ha...
...ging versus Standard Guided (Dye/Isotope) Stagi...
...de-negative patients with early-stage bre...
...nts with clinically palpable (i.e., clin...
...S-guided Staging versus Surgical St...
Figure 1. Management of the Axilla in Early-Stage Breast Cancer
...ure 1. Management of the Axilla in Early-...