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

Publication Date: March 14, 2022
Last Updated: May 2, 2022


Indications for no surgical axillary lymph node staging

  1. 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.
  2. 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%.
  3. ≥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.
  4. 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.
  5. Primary breast sarcoma or phyllodes tumor
    • The risk of nodal metastasis for breast sarcoma - including angiosarcoma and malignant phyllodes tumor - is negligible.



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

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