Early-Stage Breast Cancer
Key Points
Key Points
Clinicians should NOT recommend axillary lymph node dissection (ALND) for women with early-stage breast cancer:
Who do not have nodal metastases.
( EB , H , B , S )Who have one or two sentinel lymph node metastases and will receive breast-conserving surgery (BCS) with conventionally fractionated whole-breast radiotherapya.
( EB , H , B , S )a Clinicians should consider this recommendation with caution in patients with clinically enlarged axillary lymph nodes, those with large primary tumors (>5 cm), those with large or bulky metastatic axillary sentinel lymph nodes, and/or those with gross extranodal extension of the tumor.
Clinicians may offer ALND for women with early-stage breast cancer with nodal metastases found on sentinel lymph node (SNB) who will receive mastectomy.
( EB , L , B , W )Ductal carcinoma in situ (DCIS) when mastectomy is performed.
( IC , Ins , B , W )Prior breast and/or axillary surgery.
( EB , I , B , S )Preoperative/neoadjuvant systemic therapyb.
( EB , I , B , M )b SNB may be offered before or after neoadjuvant chemotherapy (NACT), but the false negative rate is higher afterward, and therefore, the procedure seems less accurate after NACT and may be unacceptably high with known metastatic nodes.
There are insufficient data to change the 2005 recommendation that clinicians should NOT perform SNB for women who have early-stage breast cancer and are in the following circumstances:
Inflammatory breast cancer.
( IC , Ins , , W )DCIS when breast-conserving surgery is planned.
( IC , Ins , , S )Pregnancy.
( IC , Ins , , W )Illustration of Sentinel Nodes
...tration of Sentinel Nodes...
...1. Sentinel Lymph No...