Axillary management of breast cancer

ALND: axillary lymph node dissection; ER: estrogen receptor; NACT: neoadjuvant chemotherapy; RT: radiation therapy; SLN: sentinel lymph node; SLNB: sentinel lymph node biopsy; US: ultrasound.

* NACT is often indicated for HER2+ and triple-negative disease as well as locally advanced cancers, regardless of receptor status. Refer to UpToDate topics on neoadjuvant chemotherapy for breast cancer for details.

¶ Select patients over 70 who have early-stage, ER+, HER2/neu-negative, clinically node-negative disease who will receive hormonal therapy may reasonably elect not to proceed with axillary surgery or RT.