Determining the Risk of Recurrence in HR+/HER2- Early Breast Cancer Without Axillary Dissection Authors: Sara M. Tolaney, MD, MPH; Elizabeth A. Mittendorf, MD, PhD, MHCM; Leah H. Portnow, MD

https://www.medscape.org/viewarticle/1002279?sso=true&uac=148436CN&src=mkmcmr_reeng_recap_mscpedu_activity Determining the Risk of Recurrence in HR+/HER2- Early Breast Cancer Without Axillary Dissection Below are some key learning points to help reinforce the impact of this activity. ☑ Lymph node involvement is a critical factor in determining the optimal management of patients with early-stage HR-positive, HER2-negative breast cancer. • Along with tumor size, grade, and proliferation index, lymph node involvement serves as an important prognostic factor in the management of HR-positive, HER2-negative EBC. • Escalated therapies, such as cyclin-dependent kinase (CDK) 4/6 inhibitors in the adjuvant setting, depend on understanding the degree of nodal involvement. ☑ Imaging techniques play a pivotal role in the assessment of the axilla. • Breast magnetic resonance imaging (MRI), with its wide field of view, is useful for assessing the number of lymph nodes involved but is limited in its ability to provide detailed morphologic assessment. • Ultrasound is preferred for evaluating lymph node morphology. Abnormal axillary lymph node characteristics include cortical thickness greater than 3 mm, loss of fatty hilum, non-hilar Doppler flow, and a round shape. ☑ Recent studies have provided evidence supporting the safety of omitting full ALND in select patients with EBC. • The SOUND trial demonstrated that omitting axillary surgery was noninferior to sentinel lymph node biopsy (SLNB) in patients with small breast cancers and negative ultrasonography results. • The INSEMA trial, with a median follow-up of 6 years, showed that in patients with clinically node-negative T1 or T2 invasive breast cancer, omission of surgical axillary staging was noninferior to SLNB. ☑ With expanding treatment options now available, a multidisciplinary approach to individualized treatment planning for patients with early-stage HR-positive, HER2-negative breast cancer is more important than ever.