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
...nagemen...
I. Stagi...
...ts ≥70 years of age with clinica...
...r patient...
...Statements for Staging:The information acq...
...II. Further Axillary Treatment: SLN(-)...
...uld NOT recommend ALND for women with e...
...elected patients (e.g., patients with...
...ing Statements for Further Axillar...
...r Axillary Treatment: SLN(+)...
...her Axillary Surgery Beyond SLNB Com...
...ceived breast conserving surgery. ( EB ,...
...s who had mastectomy as well as for those excl...
...y of the Axilla (LRNI) Compared with No LRNIIt...
...erapy to the Axilla Compared with Further Surger...
...erapy Compared with No TreatmentIn patients with u...
...IV. When NAC is...
...Initially Node-negative Pat...
...s who are initially clinically node-negative on...
...nitially Node-positive Patie...
...atients who were initially clinically a...
For patients who were initially clini...
...-mastectomy patients who are node-po...
...e recommend LRNI for the post-mastectomy node-...
...mmend LRNI after ALND for patients c...
...red decision-making processes should be put in pl...
...SLNB Timing: Before or After NACWe...
...entifying Sentinel Node...
...us Dual TracerFor patients having pr...
...S-guided Staging versus Standard Guided (Dye/I...
...n clinically node-negative patients wi...
...h clinically palpable (i.e., clinically p...
...ded Staging versus Surgical StagingWe recomme...
Figure 1. Management of the Axilla in Early-Stage Breast Cancer
...ment of the Axilla in Early-Stage Breast Cancer...