Primary systemic therapy is increasingly used in the treatment of patients with early-stage breast cancer, but few guidelines specifically address optimal locoregional therapies. Therefore, we established an international consortium to discuss clinical evidence and to provide expert advice on technical management of patients with early-stage breast cancer. The steering committee prepared six working packages to address all major clinical questions from diagnosis to surgery. During a consensus meeting that included members from European scientific oncology societies, clinical trial groups, and patient advocates, statements were discussed and voted on. A consensus was reached in 42% of statements, a majority in 38%, and no decision in 21%. Based on these findings, the panel developed clinical guidance recommendations and a toolbox to overcome many clinical and technical requirements associated with the diagnosis, response assessment, surgical planning, and surgery of patients with early-stage breast cancer. This guidance could convince clinicians and patients of the major clinical advancements purported by primary systemic therapy, the use of less extensive and more targeted surgery to improve the lives of patients with breast cancer.

Breast Cancer Screening and Diagnostic Center Clinic of Radiology General University Hospital Prague Prague Czech Republic

Breast Center Eastern Switzerland St Gallen Switzerland

Breast Center University Hospital Basel Basel Switzerland

Breast Center University Hospital Basel Basel Switzerland; Faculty of Medicine University of Basel Basel Switzerland

Breast Centre Aarau Cham Zug Hirslanden Klinik Aarau Switzerland

Breast Centre Aarau Cham Zug Hirslanden Klinik Aarau Switzerland; Frauenarztzentrum Aargau Ag Baden Switzerland

Breast Centre Hirslanden Klinik St Anna Luzern Switzerland; Department of Breast Surgery Gyn zentrum Luzern Luzern Switzerland

Breast Centre Hirslanden Klinik St Anna Luzern Switzerland; Department of Surgery Medical University of Vienna Vienna Austria; Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Breast Service Department of Surgery Memorial Sloan Kettering Cancer Center New York NY USA; Breast Center University Hospital Basel Basel Switzerland

Breast Surgery San Raffaele University and Research Hospital Milan Italy

Breast Surgical Oncology Unit Clinica Universidad de Navarra Universidad de Navarra Madrid Spain

Breast Unit Champalimaud Clinical Center and Foundation Lisbon Portugal

Breast Unit Champalimaud Clinical Center and Foundation Lisbon Portugal; Nova Medical School Lisbon Portugal

Brust Zentrum Zurich Zurich Switzerland

Brustzentrum Bern Biel Bern Switzerland

Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Biomedical Imaging and Image guided Therapy Division of Molecular and Gender Imaging Medical University of Vienna Vienna Austria; Breast Imaging Service Department of Radiology Memorial Sloan Kettering Cancer Center New York NY USA

Department of Breast Surgery Guy's and St Thomas' NHS Foundation Trust London UK; Breast Institute Jiahui International Hospital Shanghai China

Department of Experimental and Clinical Biomedical Sciences M Serio University of Florence Florence Italy; Radiation Oncology Unit Oncology Department Azienda Ospedaliero Universitaria Careggi Florence Italy

Department of Pathology and Biopathology Jean Perrin Comprehensive Cancer Centre University Clermont Auvergne INSERM U1240 IMoST Clermont Ferrand France

Department of Surgery Antoni van Leeuwenhoek Netherlands Cancer Institute Amsterdam Netherlands

Division of Surgery Department of Breast Surgical Oncology University of Texas MD Anderson Cancer Center Houston TX USA

Europa Donna The European Breast Cancer Coalition Milan Italy

German Breast Group Neu Isenburg Germany; Centre for Haematology and Oncology Bethanien Frankfurt Germany

Heidelberg University Hospital Heidelberg Germany

Institut Jules Bordet Brussels Belgium; l'Université Libre de Bruxelles Brussels Belgium

Institute of Pathology Philipps University Marburg and University Hospital Marburg Marburg Germany

Iridium Kankernetwerk Wilrijk Antwerp Belgium; Faculty of Medicine and Health Sciences University of Antwerp Wilrijk Antwerp Belgium

Istituto Europeo di Oncologia IRCCS and University of Milano Milan Italy

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