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B) US-guided Staging versus Standard Guided (Dye/Isotope)
Staging
➤ In clinically node-negative patients with early-stage breast cancer
where the sentinel lymph node is likely to be negative (i.e., T1
and T2), preoperative axillary ultrasound (US) staging is NOT
recommended.
➤ In patients with clinically palpable (i.e., clinically positive) lymph
nodes it is recommended to conduct US-guided core biopsy of
the axillary node to prove pathological positivity. If patients are
pathologically negative on image-guided lymph node biopsy, see
Recommendation II. Further Axillary Treatment: SLN(-). If they are
pathologically positive on image-guided lymph node biopsy, see
Recommendation III. Further Axillary Treatment: SLN(+). (Strong
Recommendation; EB-B-L)
C) US-guided Staging versus Surgical Staging
➤ We recommend that diagnostic staging by US only (i.e., not confirmed
by a biopsy) should NOT be used instead of traditional SLNB staging.
(Strong Recommendation; EB-B-I)
Qualifying Statements for Identifying Sentinel Nodes
A) Dual Tracer
• Dual tracer should be used in settings where it is expected to be a learning curve
for the operators performing the procedure (e.g., low volume centers, surgeons in
training/post-training ).
C) If Clip is Used
• If a clip is used to identify a biopsied lymph node at diagnosis, the node
containing the clip needs to be localized to make sure it is excised. If dual tracer is
used, three or more sentinel nodes have to be identified. If three or more sentinel
nodes are not identified in a patient who has had NAC according to standard
sentinel lymph node techniques, an axillary dissection is recommended.
