The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus

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 state-ments, 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 ( & PLUSMN; targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema. Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

Clinical axillary lymph node management in early breast cancer has evolved to involve the entire multidisciplinary team. The Lucerne Toolbox, a multidisciplinary consortium, addresses the challenges in clinical axillary lymph node management, proposing targeted imaging and standardized pathology as prerequisites to planning therapy, and the replacement of axillary lymph node dissection with sentinel lymph node biopsy in most scenarios. Positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.