NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer Preoperative Systemic Therapy Breast and Axillary Evaluation

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

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

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

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

See Preoperative Systemic Therapy - Primary Treatment (BINV-12)

Preoperative systemic therapy

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)

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.

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

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 ® .