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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-11
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
Preoperative Systemic Therapy Breast and Axillary Evaluation
Core biopsy with placement
of image-detectable
marker(s), if not previously
performed, must be done to
demarcate the tumor bed for
post-chemotherapy surgical
management
Clinically negative axillary
lymph node(s) should
have axillary imaging;
suspicious nodes should
be sampled by FNA or
core biopsy prior to
neoadjuvant therapy
ee
Clinically positive axillary
lymph node(s) should
be sampled by FNA or
core biopsy prior to
neoadjuvant therapy
ee
See Locoregional Treatment of Clinical Stage I, IlA, or IlB Disease
or T3, N1, M0 (BINV-3)
See Preoperative
Systemic Therapy -
Primary Treatment
(BINV-12)
Preoperative
systemic
therapy
Surgical resection
ee
Marking of sampled axillary nodes with a tattoo or clip should be considered to permit verification that the biopsy-positive lymph node has been removed at the time of
definitive surgery.
ff
Among patients shown to be node-positive prior to neoadjuvant systemic therapy, SLNB has a >10% false-negative rate when performed after neoadjuvant systemic
therapy. This rate can be improved by marking biopsied lymph nodes to document their removal, using dual tracer, and by removing more than 2 sentinel nodes.
If lymph node FNA or core
biopsy negative, SLNB can
be performed before or
after neoadjuvant systemic
therapy
If lymph node FNA or core
biopsy positive, axilla
may be restaged after
neoadjuvant systemic
therapy; ALND should
be performed if axilla is
clinically positive; SLNB or
ALND can be performed if
axilla is clinically negative
ff