How does your treatment of lymph nodes change for a breast cancer with limited (<2mm) vs more extensive ECE?

Extracapsular tumor extension (ENE) alone does not appear to increase the risk of axillary failure following axillary dissection (1, 2). There have been conflicting data on whether ENE increases the risk of local-regional failure (LRF) and whether the degree of ENE is important. Having ENE of 2 mm or greater substantially increased the LRF risk compared to when there was none or less than 2 mm extension in series from the Cleveland Clinic (3) and the MD Anderson Cancer Center (4) but not in a mo...

In patients with a dissected axilla, ECE of more than 2 mm would make us treat the undissected axilla (level 3) and supraclavicular region as it is shown to be predictive of regional relapse in retrospective series.