Axillary LN dissection
no suspicious LN at diagnosis
Clinically suspicious of LN at diagnosis
consider omitting SLN excision
SLN mapping and excision
SLN not identified
SLN negative
SLN positive
Breast conserving surgery
Mastectomy
no further Axillary surgery indicated
consider Axillary dissection of Level I / II region
criteria
- cT1-T2, cN0
- no neoadjuvant C/T
- 1 to 2 positive SLNs
- WBRT planned
No
ALND over Level I / II
Yes
no ALND indicated
micrometastasis in SLN
no ALND indicated
Criteria
- cT1-T2, cN0
- No neoadjuvant
- 1 to 2 positive SLN
- Adjuvant RT planned
No
ALND over Level I / II
Yes
consider no further ALND
micrometastasis in SLN
no ALND indication
sono-guide FNA or core Bx
negative
positive
≥ 3 positive suspicious LN
SLN mapping and excision 同上流程
Neoadjuvant therapy
≤ 2 positive LN
SLN mapping and excision 同上流程
ALND over level I / II
clinically nodes negative after neoadjuvant
meet the criteria below:
- marking biopsied LN
- dual tracer
- removing ≥ 3 SLN and all are negative
No
ALND over Level I / II
Yes
no ALND indication
residual disease
ALND over Level I / II
Neoadjuvant C/T was given
SLN mapping and excision 同上流程
for cT1N0, ER strong, HER2 negative, post-menopausal, and plan to receive breast conserving surgery and WBRT