Table 7 Summary of main recommendations and how can practice change if they are applied
Summary of recommendations | How can practice change? | |
|---|---|---|
| Evaluate genetic testing for most TNBC cases. | - Genetic counseling for patients and families. - Possibility of risk-reducing therapies. - Individualized treatment according to the presence of pathogenic mutations. |
| Individualize axillary ultrasound according to potential for treatment change. | - Avoid ALND increase in candidate patients for the ACOSOG Z0011 study. - Support the indication of adjuvant RT in cases of NAT (pN+). |
Individualize breast MRI according to potential for treatment change. | - Better surgical indication and reduction of compromised margins and re-operations. - Prioritize in the context of NAT or when surgical planning remains uncertain. - Avoid mastectomy in patients who are candidates for BCS. | |
| NAT for cN+ patients and cN0 patients with tumors larger than 1.0 cm. | - Tumor size reduction and possibility of more conservative surgery. - In-vivo assessment of response to treatment (chemosensitivity). - Possibility of adjuvant capecitabine for patients with residual disease. |
Perform some tumor marking before NAT. | - Appropriate surgical approach. - Reduction of compromised margins and re-operations. | |
Evaluate the tumor response after NAT with breast imaging exams. | - Appropriate surgical approach. - Reduction of compromised margins and re-operations. |
