Breast cancer in women
Authors: Wildiers Hans , Stordeur Sabine , Vlayen Joan , Scholten Rob , van de Wetering Fleur , Bourgain Claire , Carly B. , Christiaens M.-R. , Cocquyt V. , Lifrange E. , Schobbens J.-C. , Van Goethem Mireille , Villeirs Geert , Van Limbergen Erik , Neven P. 
Published: January 2025

1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 8 -- 1.1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 8 -- 1.2. COMPOSITION OF THE KCE EXPERT TEAM 8 -- 1.3. RESEARCHERS INVOLVED IN THE GUIDELINE UPDATE 9 -- 1.4. ACKNOWLEDGEMENTS 9 -- 2. AGREE SCORES OF IDENTIFIED GUIDELINES 10 -- 3. SEARCH STRATEGIES 15 -- 3.1. BREAST CANCER 15 -- 3.2. SEARCH FILTER SYSTEMATIC REVIEW 15 -- 3.3. SEARCH FILTER RANDOMIZED CONTROLLED TRIALS. 15 -- 3.4. DIAGNOSTIC STUDIES 15 -- 3.5. HISTOPATHOLOGIC EXAMINATION 16 -- 3.6. FOLLOW-UP 16 -- 3.7. RECURRENT DISEASE 16 -- 4. GUIDELINE UPDATE 2013 17 -- 4.1. RESEARCH QUESTIONS AND PICO 17 -- 4.2. SEARCH STRATEGIES 18 -- 4.3. STUDIES SELECTION AND QUALITY APPRAISAL 30 -- 4.3.1. Research question 1: Axillary surgery in breast cancer women with positive sentinel nodes (isolated tumour cells, micrometastases, macrometastases) 30 -- 4.3.2. Research question 2: The use of bisphosphonates in the adjuvant setting 52 -- 4.3.3. Research question 3: Use of bevacizumab for patients with HER-2 negative metastatic breast -- cancer 60 -- 4.3.4. Research question 4: Use of trastuzumab with non-anthracycline chemotherapy for patients with -- HER-2 positive breast cancer in the adjuvant setting 68 -- 5. EVIDENCE TABLES BY CLINICAL QUESTION 75 -- 5.1. DIAGNOSIS 75 -- 5.1.1. Triple assessment 75 -- 5.1.2. Diagnosis with MRI 75 -- 5.1.3. Diagnosis with scintimammography 76 -- 5.1.4. Diagnosis with PET scan 77 -- 5.1.5. Hormonal receptors assessment 80 -- 5.1.6. Tumour markers 85 -- 5.2. STAGING 89 -- 5.2.1. Magnetic Resonance Imaging (MRI) 89 -- 5.2.2. Axillary ultrasonography 95 -- 5.2.3. Positron emission tomography (PET) 97 -- 5.3. TREATMENT OF NON-INVASIVE BREAST CANCER : DCIS 102 -- 5.3.1. Surgery and Sentinel lymph node biopsy 102 -- 5.3.2. Radiotherapy 105 -- 5.3.3. Endocrine therapy 107 -- 5.4. TREATMENT OF NON-INVASIVE BREAST CANCER: PAGETS DISEASE 109 -- 5.4.1. Surgery for Pagets disease 109 -- 5.5. TREATMENT OF EARLY INVASIVE BREAST CANCER 110 -- 5.5.1. Neoadjuvant treatment 110 -- 5.5.2. Surgery to the breast 112 -- 5.5.3. Surgery to the axilla 117 -- 5.5.4. Adjuvant therapy 133 -- 5.5.5. Radiotherapy 138 -- 5.5.6. Chemotherapy 144 -- 5.5.7. Endocrine therapy for early and locally advanced disease 158 -- 5.5.8. Trastuzumab 173 -- 5.5.9. Bisphosphonates 183 -- 5.6. TREATMENT OF METASTATIC BREAST CANCER 195 -- 5.6.1. Endocrine therapy 195 -- 5.6.2. Chemotherapy 206 -- 5.6.3. Trastuzumab 216 -- 5.6.4. Bevacizumab 218 -- 5.6.5. Treatment of metastases 220 -- 5.7. MANAGEMENT OF COMPLICATIONS OF LOCAL TREATMENT 222 -- 5.8. HORMONE REPLACEMENT THERAPY 227 -- 5.9. PSYCHOLOGICAL INTERVENTION 228 -- 5.10. SURVEILLANCE (FOLLOW-UP) 229 -- 6. SUMMARY OF FINDINGS TABLES 237 -- 6.1. AXILLARY SURGERY IN EARLY INVASIVE BREAST CANCER WITH A POSITIVE SENTINEL NODE -- . 237 -- 6.2. TRASTUZUMAB IN PATIENTS WITH HER-2 POSITIVE INVASIVE (NON METASTATIC) BREAST -- CANCER. 243 -- 6.3. BISPHOSPHONATES IN EARLY BREAST CANCER WOMEN WITHOUT METASTASES 244 -- 6.4. BEVACIZUMAB IN WOMEN WITH HER-2 NEGATIVE METASTATIC BREAST CANCER 247 -- 7. FOREST PLOTS 248 -- 8. TNM CLASSIFICATION 252 -- 8.1. TNM CLINICAL CLASSIFICATION 252 -- 8.1.1. T  Primary tumour 252 -- 8.1.2. N  Regional lymph nodes 252 -- 8.1.3. M  Distant metastasis 253 -- 8.2. PTNM PATHOLOGICAL CLASSIFICATION 253 -- 8.2.1. Stage grouping 254 -- 9. CONSULTATION OF STAKEHOLDERS 255 -- 9.1. EVALUATION OF THE RECOMMENDATIONS : DELPHI CONSULTATION, FIRST TOUR 255 -- 9.2. EVALUATION OF THE RECOMMENDATIONS: DELPHI CONSULTATION, SECOND TOUR 256 -- 9.3. EVALUATION OF THE RECOMMENDATIONS: DELPHI CONSULTATION, THIRD TOUR 257 -- 9.4. MEETING WITH PATIENTS REPRESENTATIVES 257 -- 10. SET OF QUALITY INDICATORS 258 -- 11. REFERENCES 263