BS09STAGING AND MANAGING THE AXILLA IN EARLY BREAST CANCER - GUIDELINES FOR BEST PRACTICE

Evidence-based guidelines assist clinicians to integrate research into practice. National Breast and Ovarian Cancer Centre (NBOCC) has systematically reviewed current evidence and developed recommendations for staging and managing the axilla in early breast cancer (EBC). NBOCC guidelines for sentinel node biopsy (SNB) were presented at RACS in 2008, supporting SNB as an alternative to axillary dissection (AD) in suitable women with EBC. However, guidelines for non-SNB-based axillary management are also required. A multidisciplinary working group including consumers oversaw the systematic review addressing: AD versus 4-node sampling in axillary staging; AD versus non-surgical methods in axillary staging; the optimal extent of AD; the prognostic significance of the number of nodes retrieved and the proportion of involved nodes identified at AD; long-term outcomes of AD; and axillary irradiation (with or without AD) following breast surgery. Evaluation of the evidence informed the development of guideline recommendations by the working group. Eleven randomised trials were identified, however the majority of evidence was from non-randomised trials. Imaging alone is not recommended for routine staging, and for most patients, surgical staging of the axilla is required. For women undergoing AD, level I or II AD is recommended. For women in whom axillary dissection is contraindicated, radiotherapy of the axilla is recommended. Implications and further recommendations for clinical practice will be discussed. Guidance for clinical practice is vital where evidence is inconsistent. Axilla management in EBC is once such area, emphasising the importance of new NBOCC guidelines. [PUBLICATION ABSTRACT]