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
...I. Staging...
...70 years of age with clinically node-negat...
...patients...
...g Statements for Staging:The information acq...
...II. Further...
...ld NOT recommend ALND for women with early-stage b...
...e selected patients (e.g., patients w...
Qualifying Statements for Further Axil...
...III. Further...
...illary Surgery Beyond SLNB Compared with ALND...
...e who received breast conserving surg...
...patients who had mastectomy as well as for th...
...Radiotherapy of the Axilla (LRNI) Compared...
...Radiotherapy to the Axilla Compared with Fur...
...Compared with No TreatmentIn patients w...
...IV....
...A) I...
...who are initially clinically node-ne...
B) I...
...who were initially clinically and biopsy-p...
...who were initially clinically and biopsy-p...
...ost-mastectomy patients who are node-positi...
...nd LRNI for the post-mastectomy node...
...NI after ALND for patients clinically...
...ecision-making processes should be put in plac...
...: Before or After NACWe recommend against per...
...ingle versus Dual TracerFor patien...
...de-negative patients with early-sta...
...with clinically palpable (i.e., clini...
...guided Staging versus Surgical Stagi...
Figure 1. Management of the Axilla in Early-Stage Breast Cancer
...igure 1. Management of the Axilla in Early-St...