10
Management
Figure 1. Management of the Axilla in Early-Stage Breast Cancer
If mastectomy
or BCT and ≥3
nodes positive
Standard RT
(consider regional
RT in selected
patients)
b
No ALND
b
No axillary staging in
selected groups (e.g.
age >70 yrs, ER positive,
comorbidities)
b
NAC
Axillary ultrasound
pre NAC for staging
Clinically node negative
a
No axillary ultrasound
for staging
Standard whole
breast or chest
wall RT
(loco-regional RT in
selected patients)
b
If BCT, 1–2 nodes
positive, and
planning RT
e
Node positive
e
Node negative
If mastectomy,
1–2 nodes
positive
Single tracer (radiocolloid)
if primary surgery; if non-
identification or low volume
center, use dual dye
SLNB
c
a
Refers to all patients with no palpable axillary nodes on physical examination, including those who
may have had an ultrasoun d that was equivocal, abnormal, or even biopsy proven positive.
b
Decision making should be made on a case by case basis, and include a patient centered approach;
that is, consider and discuss pros and cons of various options in light of patient patient's specific
circumstances, values, and preferences.
c
Do not recommend SLNB before chemotherapy except in special circumstances aer
multidisciplinary discussion.
No ALND
ALND
b
Loco-regional RT
High risk patients Low risk patients
No
NAC
