London Health Sciences Centre, London, Ontario, Canada.
Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
J Clin Oncol. 2021 Sep 20;39(27):3056-3082. doi: 10.1200/JCO.21.00934. Epub 2021 Jul 19.
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.
为早期乳腺癌患者的腋窝管理以及最佳治疗（手术和放疗）策略提供建议。
安大略省健康（安大略省癌症护理）和 ASCO 召集了一个工作组和专家小组，根据对文献的系统审查制定循证建议。
本指南认可了 ASCO 2017 年指南中关于早期乳腺癌患者前哨淋巴结活检使用的两项建议，并对该指南进行了扩展，包括放疗干预、新辅助化疗（NAC）后分期的时机以及绘图方式的建议。总的来说，ASCO 2017 指南、七项高质量系统评价、54 项独特研究和 65 项相关试验构成了本指南的证据基础。
为该指南的每个目标都发布了建议：（1）确定哪些早期乳腺癌患者需要腋窝分期，（2）确定对于未接受 NAC 且在诊断时前哨淋巴结阴性的早期乳腺癌女性是否需要进一步进行腋窝治疗，（3）确定对于未接受 NAC 且在诊断时前哨淋巴结阳性（在临床淋巴结阴性表现后）的早期乳腺癌女性，应采用哪种腋窝策略，（4）确定在使用 NAC 时，早期乳腺癌女性的腋窝治疗方法以及腋窝治疗的最佳时机，（5）确定在使用 NAC 时，哪些是识别前哨淋巴结的最佳方法。更多信息可在 www.asco.org/breast-cancer-guidelines 上获取。
