Surg-6	Surgical treatment of the axilla
	a. Determination of the histological node status (pN status) is part of the surgical treatment of invasive breast cancer. This should be done by means of sentinel lymph node biopsy (SLNB).
GCP	(Kuehn T et al. 2005; Lyman GH et al. 2005; NICE 2009; NZGG 2009)
	b. SLNB is equivalent to axillary dissection in terms of local control in SLN-negative patients.
Level of evidence 1b	(Krag DN et al. 2010; NZGG 2009)
	c. Morbidity after SLNB is significantly reduced compared with axillary dissection.
Level of evidence 1a	(Fleissig A et al. 2006; Mansel RE et al. 2006; NICE 2009; Veronesi U et al. 2003)
	d. Axillary dissection must be performed in patients in whom no SLN is detected.
GCP
Grade of recommendation A	e. In patients who exhibit a positive SLN (macrometastasis), axillary dissection with removal of at least 10 lymph nodes from levels I and II is indicated.
Level of evidence 1b	(NZGG 2009)
	f. For patients with pT1-pT2/cN0 tumors undergoing breast-conserving surgery followed by tangential field irradiation and who exhibit one or two positive sentinel lymph nodes, there is the option of refraining from axillary dissection.
GCP	(Giuliano AE et al. 2010)
	g. This procedure requires extensive preliminary information and briefing of the patient.The process and outcome quality must be evaluated prospectively in conjunction with quality assuring measures.
GCP
	h. Axillary dissection is not necessary if only micrometastases are present.
GCP