Adequate excision: surgical removal of all clinically evident disease in the breast and lymph nodes as follows:
Breast surgery: total mastectomy with no gross residual disease at the margin of resection, or breast-conserving surgery with histologically negative margins of excision
For patients who undergo breast-conserving surgery, the margins of the resected specimen must be histologically free of invasive tumor and DCIS as determined by the local pathologist. If pathologic examination demonstrates tumor at the line of resection, additional operative procedures may be performed to obtain clear margins. If tumor is still present at the resected margin after re-excision(s), the patient must undergo total mastectomy to be eligible. Patients with margins positive for lobular carcinoma in situ (LCIS) are eligible without additional resection.
Lymph node surgery:
In case of positive results from a fine-needle aspiration, core biopsy, or sentinel node biopsy performed prior to preoperative therapy, additional surgical evaluation of the axilla following preoperative therapy is required.
If only micrometastases are present in sentinel nodes preoperatively (i.e., if the greatest diameter of the nodal metastasis in a sentinel node is 0.2 mm or less), no additional surgical evaluation of the axilla is required.
If sentinel node biopsy performed before preoperative therapy was negative, no additional surgery evaluation of the axilla is required after preoperative therapy.
If the only sentinel node identified by isotope scan is in the internal mammary chain, surgical evaluation of the axilla is recommended.
If sentinel node biopsy performed after preoperative therapy is positive, additional surgical evaluation of the axilla is recommended.
If sentinel node evaluation after preoperativetherapy is negative, no further additional surgical evaluation of the axilla is required.
Axillary dissection without sentinel node evaluation is permitted after preoperative therapy.