Annals of Surgical Oncology

, Volume 22, Issue 10, pp 3184–3190 | Cite as

Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer

  • Dennis Holmes
  • A. Colfry
  • Brian Czerniecki
  • Diana Dickson-Witmer
  • C. Francisco Espinel
  • Elizabeth Feldman
  • Kristalyn Gallagher
  • Rachel Greenup
  • Virginia Herrmann
  • Henry Kuerer
  • Manmeet Malik
  • Eric Manahan
  • Jennifer O’Neill
  • Mita Patel
  • Molly Sebastian
  • Amanda Wheeler
  • Rena Kass
Breast Oncology



The American Society of Breast Surgeons (ASBrS) sought to provide an evidence-based guideline on the use of neoadjuvant systemic therapy (NST) in the management of clinical stage II and III invasive breast cancer.


A comprehensive nonsystematic review was performed of selected peer-reviewed literature published since 2000. The Education Committee of the ASBrS convened to develop guideline recommendations.


A performance and practice guideline was prepared to outline the baseline assessment and perioperative management of patients with clinical stage II–III breast cancer under consideration for NST.


Preoperative or NST is emerging as an important initial strategy for the management of invasive breast cancer. From the surgeon’s perspective, the primary goal of NST is to increase the resectability of locally advanced breast cancer, increase the feasibility of breast-conserving surgery and sentinel node biopsy, and decrease surgical morbidity. To ensure optimal patient selection and efficient patient care, the guideline recommends: (1) baseline breast and axillary imaging; (2) minimally invasive biopsies of breast and axillary lesions; (3) determination of tumor biomarkers; (4) systemic staging; (5) care coordination, including referrals to medical oncology, radiation oncology, plastic surgery, social work, and genetic counseling, if indicated; (6) initiation of NST; (7) post-NST breast and axillary imaging; and (8) decision for surgery based on extent of disease at presentation, patient choice, clinical response to NST, and genetic testing results, if performed.


Sentinel Node Sentinel Node Biopsy Axillary Lymph Node Dissection National Comprehensive Cancer Network Breast Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Dennis Holmes
    • 1
  • A. Colfry
    • 2
  • Brian Czerniecki
    • 3
  • Diana Dickson-Witmer
    • 4
  • C. Francisco Espinel
    • 5
  • Elizabeth Feldman
    • 6
  • Kristalyn Gallagher
    • 7
  • Rachel Greenup
    • 8
  • Virginia Herrmann
    • 9
  • Henry Kuerer
    • 10
  • Manmeet Malik
    • 11
  • Eric Manahan
    • 12
  • Jennifer O’Neill
    • 13
  • Mita Patel
    • 14
  • Molly Sebastian
    • 5
  • Amanda Wheeler
    • 15
  • Rena Kass
    • 16
  1. 1.Department of SurgeryLos Angeles Center for Women’s HealthLos AngelesUSA
  2. 2.Department of SurgeryMD Anderson Cancer CenterHoustonUSA
  3. 3.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of SurgeryHelen F. Graham Cancer CenterNewarkUSA
  5. 5.Department of SurgeryVirginia Hospital CenterArlingtonUSA
  6. 6.Department of SurgeryColumbia UniversityNew YorkUSA
  7. 7.Department of SurgeryOklahoma State University Medical CenterTulsaUSA
  8. 8.Department of SurgeryDuke UniversityDurhamUSA
  9. 9.Department of SurgeryWashington UniversitySt. LouisUSA
  10. 10.Department of Surgical OncologyMD Anderson Cancer CenterHoustonUSA
  11. 11.Department of SurgeryNew York Hospital QueensFlushingUSA
  12. 12.Department of SurgeryHamilton Medical CenterDaltonUSA
  13. 13.Arizona Associated SurgeonsPhoenixUSA
  14. 14.Akron General Medical CenterAkronUSA
  15. 15.Department of SurgeryStanford UniversityPalo AltoUSA
  16. 16.Department of SurgeryPenn State Hershey Medical CenterHersheyUSA

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