- Clinicians should NOT recommend axillary lymph node dissection (ALND) for women with early-stage breast cancer:
- Clinicians may offer ALND for women with early-stage breast cancer with nodal metastases found on sentinel lymph node (SNB) who will receive mastectomy (Weak Recommendation: EB-B-L).
- Clinicians may offer SNB for women who have operable breast cancer who have the following circumstances:
- There are insufficient data to change the 2005 recommendation that clinicians should NOT perform SNB for women who have early-stage breast cancer and are in the following circumstances:
a Clinicians should consider this recommendation with caution in patients with clinically enlarged axillary lymph nodes, those with large primary tumors (>5 cm), those with large or bulky metastatic axillary sentinel lymph nodes, and/or those with gross extranodal extension of the tumor.
b SNB may be offered before or after neoadjuvant chemotherapy (NACT), but the false negative rate is higher afterward, and therefore, the procedure seems less accurate after NACT and may be unacceptably high with known metastatic nodes.