How would you manage a patient with a negative axillary ultrasound but no sentinel lymph node evaluation at the time of lumpectomy for early-stage breast cancer?

If the patient meets PRIME criteria, one can do either APBI or FAST-Forward, based on the preference of the patient. If doesn’t meet PRIME criteria, favor a whole breast like the SOUND study.

This was looked at retrospectively a couple of years ago.

Keelan et al., PMID 33837870

The authors conclude that it was not acceptable to omit surgical staging for T2 tumors, but maybe for T1s.

Personally, given that T1a lesions have about a 5% axillary positivity rate, and T1b lesions are 10% positiv...