US: ultrasound; NACT: neoadjuvant chemotherapy; SLNB: sentinel lymph node biopsy; SLN: sentinel lymph node; ALND: axillary lymph node dissection; RT: radiation therapy; ER: estrogen receptor.
* NACT is often indicated for HER2+ and triple-negative disease as well as locally advanced cancers, regardless of receptor status. Refer to UpToDate topics on neoadjuvant chemotherapy for breast cancer for details.
¶ Select patients over 70 who have early-stage, ER+, HER2/neu-negative, clinically node-negative disease who will receive hormonal therapy may reasonably elect not to proceed with axillary surgery or RT.
Δ The practice of offering regional RT to patients with 0, 1, or 2 positive sentinel lymph nodes varies between centers.