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Recommendation
Management of the axilla – Indications for further axillary treatment #1
Discuss further axillary treatment (axillary node clearance or radiation therapy) in patients who have more than two macrometastases.
Offer further axillary treatment (axillary node clearance or radiotherapy) after SLNB to people who have 1 or more sentinel lymph node macrometastases
Further axillary surgery following positive SLNB is not required in case of low axillary disease burden (micrometastases or 1–2 SLNs containing metastases, treated with postoperative tangential breast RT) (Level of evidence – II)
Strong evidence for efficacy with a substantial clinical benefit, strongly recommended
How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK) under the heading ‘Evaluation and management of a positive axillary lymph node identified by a sentinel lymph node biopsy (in people with a normal preoperative ultrasound-guided needle biopsy’. The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording ('Offer') indicative of a strong recommendation (using GRADE methods) by the source guideline authors. The wording was made less directive as the adapted wording reflected a ‘narrower situation’ than that described in the source recommendation.
This recommendation is also supported by a source recommendation from the ESMO (2019) early breast cancer guidelines (Europe), graded 'A' (using adapted Infectious Diseases Society of America-United States Public Health Service Grading System) which indicates that further axillary surgery is not required for the converse scenario, i.e. low axillary disease burden.
Management of the axilla – Indications for further axillary treatment #1
Recommendation
Discuss further axillary treatment (axillary node clearance or radiation therapy) in patients who have more than two macrometastases.
Principles in action
Patient-centred care
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Care coordination
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Communication
This recommendation was adapted from the NICE 2018 guidelines (UK) under the heading ‘Evaluation and management of a positive axillary lymph node identified by a sentinel lymph node biopsy (in people with a normal preoperative ultrasound-guided needle biopsy’. The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording ('Offer') indicative of a strong recommendation (using GRADE methods) by the source guideline authors. The wording was made less directive as the adapted wording reflected a ‘narrower situation’ than that described in the source recommendation.
This recommendation is also supported by a source recommendation from the ESMO (2019) early breast cancer guidelines (Europe), graded 'A' (using adapted Infectious Diseases Society of America-United States Public Health Service Grading System) which indicates that further axillary surgery is not required for the converse scenario, i.e. low axillary disease burden.