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Axillary LN dissection - Coggle Diagram
Axillary LN dissection
no suspicious LN at diagnosis
consider omitting SLN excision
for cT1N0, ER strong, HER2 negative, post-menopausal, and plan to receive breast conserving surgery and WBRT
SLN mapping and excision
SLN not identified
consider Axillary dissection of Level I / II region
SLN negative
no further Axillary surgery indicated
SLN positive
Breast conserving surgery
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 indication
Mastectomy
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
Neoadjuvant C/T was given
SLN mapping and excision 同上流程
Clinically suspicious of LN at diagnosis
sono-guide FNA or core Bx
negative
SLN mapping and excision 同上流程
positive
≥ 3 positive suspicious LN
ALND over level I / II
Neoadjuvant therapy
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
≤ 2 positive LN
SLN mapping and excision 同上流程