Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy ( ± targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.

Breast Cancer Radiation Therapy Unit Sheba Medical Center Ramat Gan Israel

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

Breast Center Bern Biel Hirslanden Clinic Salem Bern Switzerland

Breast Center Eastern Switzerland St Gallen Switzerland

Breast Center Heidelberg Klinik St Elisabeth Heidelberg Germany

Breast Center Hirslanden Clinic Aarau Frauenarztzentrum Aargau AG Baden Switzerland

Breast Center Hirslanden Clinic St Anna 6006 Lucerne Switzerland

Breast Center University Hospital Basel Basel Switzerland

Breast Center Zurich Zurich Switzerland

Breast Imaging Service Department of Radiology Memorial Sloan Kettering Cancer Center New York NY USA

Breast Service Department of Surgery Memorial Sloan Kettering Cancer Center New York NY USA

Breast Surgery Department Athens Medical Center Greece

Breast Surgery San Raffaele University and Research Hospital Milan Italy

Breast Surgical Oncology Clinica Universidad de Navarra Madrid Spain

Breast Unit Champalimaud Foundation and University of Lisbon Faculty of Medicine Lisbon Portugal

Cancer Research Institute Seoul National University Seoul Republic of Korea

Centre for Haematology and Oncology Bethanien Frankfurt Germany

Department of Experimental and Clinical Biomedical Sciences M Serio University of Florence Florence Italy

Department of Gynecology and Obstetrics University of Ulm Germany

Department of Hematology Oncology and Radiation Physics Skåne University Hospital Lasarettsgatan 23A 22241 Lund Sweden

Department of Histopathology University of Geneva 1202 Geneva Switzerland

Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden

Department of Obstetrics and Gynecology Heidelberg University Hospital Germany

Department of Oncology and Hemato Oncology University of Milan Milan Italy

Department of Oncology and Metabolism The University of Sheffield The Medical School Sheffield UK

Department of Pathology Aarhus University Hospital Aarhus Denmark

Department of Radiation Oncology GROW School for Oncology and Developmental Biology Maastricht University Medical Centre Maastricht the Netherlands

Department of Radiation Oncology Iridium Netwerk Antwerp 2610 Belgium

Department of Surgery Breast Centre Capio St Göran's Hospital Stockholm Sweden

Department of Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Republic of Korea

Department of Surgical Oncology Netherlands Cancer Institute Antoni van Leeuwenhoek and Amsterdam University Medical Center Netherlands

Division of Breast Surgery Department of Surgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul 06351 Korea

Division of New Drugs and Early Drug Development European Institute of Oncology IRCCS Via Giuseppe Ripamonti 435 20141 Milano MI Italy

Division of Oncology Department of Clinical Sciences Lund University Lund Sweden

German Breast Group C o GBG Forschungs GmbH 63263 Neu Isenberg Germany

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

National Center for Tumor Diseases Heidelberg Germany

Onko hämatologisches Zentrum Zug Switzerland

Radiation Oncology Unit Azienda Ospedaliero Universitaria Careggi University of Florence Florence Italy

Sackler School of Medicine Tel Aviv University Tel Aviv Israel

University of Antwerp Faculty of Medicine and Health Sciences Antwerp Belgium

University of Basel Basel Switzerland

University of Lucerne Faculty of Health Sciences and Medicine Lucerne Switzerland

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Breast cancer: evaluating the axilla before, during, and after therapy-new challenges

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer