What are the ASCO guidelines on lymph node dissection and biopsy in the surgical treatment of early stage breast cancer?

Updated: Feb 13, 2019
  • Author: Mary Jo Wright, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

The American Society of Clinical Oncology (ASCO) released updated guidelines on the use of lymph node dissection and biopsy for patients with early stage breast cancer. Recommendations included the following [1, 2] :

  • Women without sentinel lymph node (SLN) metastases should not undergo axillary lymph node dissection (ALND)

  • In most cases, ALND should not be performed on women with 1-2 metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy

  • ALND should be offered to women with SLN metastases who will be undergoing mastectomy

  • SLN biopsy may be offered to women who have operable breast cancer and multicentric tumors, women with ductal carcinoma in situ who will be undergoing mastectomy, women who have had previous breast and/or axillary surgery, and women who have been treated with preoperative/neoadjuvant systemic therapy

  • SLN biopsy should not be performed on women with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or who are pregnant


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