Axillary Management for Patients With In-Situ and Invasive Breast Cancer

Publication Date: March 14, 2022

Last Updated: May 2, 2022

Recommendations

When surgical nodal staging will not affect adjuvant therapy recommendations.
- Axillary staging is of little value in the setting of advanced age, serious comorbidities, or when it will not affect decisions regarding adjuvant therapy.
Pure DCIS undergoing breast-conserving surgery.
- Patients with DCIS and no clinical or radiologic suspicion of invasion do not require axillary staging. The overall risk of nodal metastasis for DCIS is approximately 1-2%.
≥70 years of age with cT1-2N0 hormone receptor positive breast cancer
- 62% of patients in the CALGB 9343 RCT did not have axillary staging. Survival was unaffected, and only 3% developed axillary recurrence. This trial is the basis of the current SSO Choosing Wisely guideline recommendation against routine SLNB in patients age 70+ with HR+/HER2- invasive breast cancer.
Prophylactic mastectomy
- Axillary staging is not recommended for prophylactic mastectomy, as the likelihood of incidentally finding invasive cancer is about 2% and about 1% for nodal metastases.
Primary breast sarcoma or phyllodes tumor
- The risk of nodal metastasis for breast sarcoma - including angiosarcoma and malignant phyllodes tumor - is negligible.