Synopsis
Select pretreatment node sampling, sentinel-node biopsy, clearance or radiotherapy from proven axillary burden while minimising lymphoedema and shoulder morbidity.
- Pretreatment axillary ultrasound is required for early and locally advanced invasive breast cancer; sample morphologically abnormal nodes under ultrasound guidance.
- Use sentinel-node biopsy rather than clearance to stage an ultrasound-normal axilla or one with a negative targeted node biopsy, because microscopic disease may remain despite normal imaging.
- NICE recommends the dual localisation technique with isotope and blue dye for sentinel-node biopsy in a validated service.
Investigation priorities
Identify suspicious nodes and select a representative target before surgery or systemic therapy.
Management branches
A patient having primary surgery for invasive cancer has a normal axillary examination and ultrasound.
- In this illustrative primary-surgery case, pretreatment axillary ultrasound is normal and there has been no neoadjuvant systemic therapy. The patient discusses sentinel mapping and its allergy, sensory, seroma and lymphoedema risks, then chooses breast surgery with sentinel-node biopsy rather than routine axillary clearance.
- The team performs the planned dual isotope and blue-dye procedure. Pathology reports one 0.8 mm deposit in a sentinel node, with no macrometastasis in the other sampled nodes. The measured deposit is a micrometastasis, not a deposit exceeding 2 mm.