11
Loco-regional RT
b
If mastectomy or
BCT: SLNB
c
ALND unless part
of a clinical trial
Loco-regional RT
b
Dual tracer
post NAC, or
clipping and
≥3 nodes
d
Clinically node positive
US-guided lymph node
biopsy to confirm diagnosis
Restage after NAC
Clinically node
positive post NAC
ALND
Clinically node
negative post NAC
ALND
Node positive
e
Node negative
Standard whole
breast or chest
wall RT
(loco regional RT in
selected patients)
b
No ALND
NAC patients
Primary surgery
patients
d
Evidence supports the use of dual localizing tracer (blue dye and radio isotope) and harvesting
≥3 nodes or else do ALND to minimize false negative rate; any clipped positive nodes should be
localized for surgery.
e
In rare circumstances (e.g., a small T1aN1) it is possible to avoid radiation (see Justification of
Recommendation IIID).
