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
