Table 1.
Current indications for axillary lymph node dissection.
| Clinical setting | Type of surgery | Nodal status | Primary axillary surgery procedure | Indication for ALND |
|---|---|---|---|---|
| After NACT |
cN0 | SLNB | Any residual diseasea | |
| cN1 → cN0 | SLNB (>2 neg. SLN) or TAD | Any residual diseasea, <3 negative SLNb | ||
| cN1 → cN1 |
ALND |
|||
| Upfront surgery | BCS +WBR | cN0 | SLNBc | ≥ 3 positive SLN, cT3-4 |
| cN1 | ALND | |||
| Mastectomy | cN0 | SLNB | SLN-macrometastasis if no PMRT is planned | |
| cN1 or inflammatory breast cancer | ALND |
NACT = neoadjuvant chemotherapy; SLNB = sentinel lymph node biopsy; SLN = sentinel lymph node; TAD = Targeted axillary dissection; ALND = axillary lymph node dissection; BCS = breast conserving surgery; WBR = whole breast radiotherapy; PMRT = postmastectomy radiotherapy.
a
Some centers omit ALND in case of isolated tumor cells.
b
Some centers omit ALND when <3 negative SLN are removed.
c
In case of 1 or 2 metastases with additional risk factors (e.g., microscopic extracapsular tumor extension, lymphovascular invasion), nodal irradiation can be considered.