Axilla Management in Early-Stage Breast Cancer

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2 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 Recommendation Grading Type Benefit/Harm Evidence Quality Strength of Recommendation EB Evidence- based B Benefits outweigh harms H High Strong CB Consensus- based H Harms outweigh benefits I Intermediate Moderate IC Informal consensus B/H Relative balance of benefits and harms L Low Weak Ins Insufficient

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