# Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline.

**Organizacion:** ASCO
**Autores:** Brackstone M, Baldassarre FG, Perera FE et al.
**Revista:** J Clin Oncol (2021)
**PMID:** 34279999 | **PMCID:** -
**DOI:** [10.1200/JCO.21.00934](https://doi.org/10.1200/JCO.21.00934)
**Fuente:** PubMed (abstract only)

## Relevancia
Guia oficial de la American Society of Clinical Oncology que estandariza el manejo axilar en cancer de mama estadio temprano, incluyendo recomendaciones especificas tras quimioterapia neoadyuvante (NAC). Define cuando es aceptable la biopsia selectiva de ganglio centinela (BSGC) post-NAC y cuando persiste la indicacion de linfadenectomia (ALND), basandose en revision sistematica de literatura.

## Recomendaciones clave (resumen)
- BSGC post-NAC permitida en pacientes cN0 que se convierten a ypN0 (no requiere ALND).
- En pacientes cN+ al diagnostico, la ALND tradicional sigue siendo estandar, aunque la BSGC con tecnicas que mejoran identificacion (TAD, doble trazador) es opcion aceptable en respondedoras.
- Recomienda no realizar ALND en pacientes con BSGC negativa post-NAC.
- Marcaje del ganglio sospechoso al diagnostico se considera buena practica para mejorar precision.

## Abstract
To provide recommendations on the best strategies for the management and on the best timing and treatment (surgical and radiotherapeutic) of the axilla for patients with early-stage breast cancer.

Ontario Health (Cancer Care Ontario) and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature.

This guideline endorsed two recommendations of the ASCO 2017 guideline for the use of sentinel lymph node biopsy in patients with early-stage breast cancer and expanded on that guideline with recommendations for radiotherapy interventions, timing of staging after neoadjuvant chemotherapy (NAC), and mapping modalities. Overall, the ASCO 2017 guideline, seven high-quality systematic reviews, 54 unique studies, and 65 corollary trials formed the evidentiary basis of this guideline.

Recommendations are issued for each of the objectives of this guideline: (1) To determine which patients with early-stage breast cancer require axillary staging, (2) to determine whether any further axillary treatment is indicated for women with early-stage breast cancer who did not receive NAC and are sentinel lymph node-negative at diagnosis, (3) to determine which axillary strategy is indicated for women with early-stage breast cancer who did not receive NAC and are pathologically sentinel lymph node-positive at diagnosis (after a clinically node-negative presentation), (4) to determine what axillary treatment is indicated and what the best timing of axillary treatment for women with early-stage breast cancer is when NAC is used, and (5) to determine which are the best methods for identifying sentinel nodes.Additional information is available at www.asco.org/breast-cancer-guidelines.

## Acceso
Via [DOI](https://doi.org/10.1200/JCO.21.00934) o suscripcion institucional.

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*Datos de PubMed. Citar: doi 10.1200/JCO.21.00934*
