Axilla Management in Early-Stage Breast Cancer

Publication Date: July 19, 2021

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...

...tients ≥70 years of age with clinically node-ne...

...or patien...

...ng Statements for Staging:The information acquir...


...Further Axillary Treatment...

...linicians should NOT recommend ALN...

...me selected patients (e.g., patients with mediall...

...ing Statements for Further Axillary T...


...I. Further Axillary Treatment: SLN(+)

...o Further Axillary Surgery Beyond SLNB Compare...

...hose who received breast conserving surge...

...ients who had mastectomy as well as...

...Radiotherapy of the Axilla (LRNI) Compared wi...

...rapy to the Axilla Compared with Further...

...otherapy Compared with No TreatmentIn pat...


...IV. When NAC is...

...Initially Node-negative Patients...

...are initially clinically node-negative on...

...) Initially Node-positive...

...patients who were initially clinical...

...who were initially clinically and biopsy-p...

...ectomy patients who are node-positive on surgical...

...recommend LRNI for the post-mastectomy node-positi...

...e recommend LRNI after ALND for patients clini...

...hared decision-making processes should be put in...

...ing: Before or After NACWe recommend against p...


...ifying Sentinel Nodes...

...us Dual TracerFor patients having prima...

...US-guided Staging versus Standard Guided (Dye/I...

...inically node-negative patients with early...

...patients with clinically palpable (i.e., c...

...ded Staging versus Surgical Stagin...


Figure 1. Management of the Axilla in Early-Stage Breast Cancer

...Management of the Axilla in Early-Stage...