All patients must have had an axillary ultrasound with fine needle aspiration (FNA) or core needle biopsy of axillary lymph nodes documenting axillary metastasis at the time of diagnosis, prior to or at most 14 days after starting neoadjuvant chemotherapy\r\n* Note: Biopsy of intramammary nodes does not fulfill eligibility criteria
Patients with histologically positive axillary nodes post neoadjuvant therapy
Undergone incisional and/or excisional biopsy of primary tumor and/or axillary lymph nodes
Diagnosed with pathologically (histologically) proven invasive mammary carcinoma (ductal, lobular or other) of the breast who have undergone either mastectomy or lumpectomy with any type of axillary surgery or axillary sampling
INCLUSION - ENROLLMENT: cT1-2N0 on clinical staging (verified to have no suspicious axillary or internal mammary nodes on magnetic resonance imaging [MRI] or ultrasound)
Metastatic breast cancer (local spread to axillary or internal mammary lymph nodes is permitted)
(For Cohort B only): Presence of metastatic disease or prior radiation therapy of the primary breast carcinoma or axillary lymph nodes
Either clinically positive (N1 only) or clinically negative axillary nodes (N0)
Patients have had prior radiotherapy for primary breast carcinoma or axillary lymph nodes
More than 3 histologically positive axillary lymph nodes or axillary lymph nodes with microscopic or macroscopic extracapsular extension
Positive non-axillary sentinel nodes or evidence of suspicious supraclavicular, infraclavicular, or internal mammary nodes by imaging or physical exam, unless biopsied and found to be negative for tumor
Patients who had prior radiation therapy of the primary breast carcinoma or axillary lymph nodes
Prior radiation therapy of the primary breast carcinoma or axillary lymph nodes
N-1, N-2, or N-3 pathologic axillary nodes
Any non-axillary sentinel node(s) positive; (note that intramammary nodes are staged as axillary nodes)
Palpable or radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes, unless there is histological confirmation that these nodes are negative for tumor
More than 3 histologically positive axillary nodes
Axillary nodes with definite evidence of microscopic or macroscopic extracapsular extension
Palpable or radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes at time of enrollment unless there is histologic confirmation that these nodes are negative for tumor
Greater than 9 positive axillary nodes/sentinel biopsy
Palpable or radiographically suspicious contralateral axillary, supraclavicular, infraclavicular or internal mammary nodes, unless there is histologic confirmation that these nodes are negative for tumor
More than 3 positive axillary nodes on imaging or matted nodes on clinical exam
Clinically positive axillary lymph nodes
For patients with invasive breast cancer, an axillary staging procedure must be performed (either sentinel node biopsy [SNB] alone or axillary dissection [with a minimum of six axillary nodes removed], and the axillary node[s] must be pathologically negative); patients over 70 with estrogen receptor positive (ER+) tumors no greater than 2 cm do not require axillary evaluation, but MUST be clinically node negative on examination and all available imaging (clinical N0)
Prior axillary dissection.
One to 5 involved lymph nodes identified at axillary staging
More than 5 involved nodes identified at axillary staging
Participants who have undergone incisional and/or excisional biopsy of primary tumor and/or axillary lymph nodes
American Joint Committee on Cancer (AJCC) 7th edition stage 0 or I (Tis N0 =< 2 cm or T1 N0) histologically confirmed carcinoma of the breast, treated with partial mastectomy; axillary sampling is required only for cases of invasive cancers; tumor size is determined by the pathologist; clinical size may be used if the pathologic size is indeterminate; patients with invasive cancer must have no positive axillary lymph nodes with at least 6 axillary lymph nodes sampled or a negative sentinel node
Histologically confirmed positive axillary nodes in the ipsilateral axilla; palpable or radiographically suspicious contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes, unless there is histologic confirmation that these nodes are negative for tumor
Primary tumor =< 4 cm and 0-3 positive axillary lymph nodes (T1-2, N0-1, M0)
Pathological evidence of residual invasive carcinoma in the breast or axillary lymph nodes following completion of preoperative therapy
Participants must have histologically confirmed invasive breast cancer confined to the breast and regional lymphatics (supraclavicular, axillary, internal mammary lymph nodes)
Locally advanced or metastatic Her2/Neu positive breast cancer (defined as immunohistochemistry [IHC] 3+ or a fluorescence in situ hybridization [FISH] ratio of >= 2.0); this may be on either a primary tumor or a metastatic site, and there is no time limit from the time the specimen was obtained; locally advanced breast cancer (LABC) includes breast cancers with advanced primary tumors, i.e., large diameter (at least 5 cm) or those with skin and/or chest wall involvement, and advanced regional lymph node involvement; it also includes a rare subgroup, inflammatory breast cancer; in the 2010 American Joint Committee on Cancer and the International Union for Cancer Control (AJCC-UICC) TNM breast cancer staging system, locally advanced breast cancer (LABC) includes patients with stage III disease; this comprises:\r\n* Advanced primary tumors (tumors > 5 cm in greatest dimension [T3]; direct extension to the chest wall and/or to the skin [T4]: ulceration, skin nodules, and/or edema (including peau d'orange) confined to the same breast, inflammatory breast cancer [IBC, T4d])\r\n* Advanced regional lymph nodes (ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted or clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases [N2], ipsilateral infraclavicular [level III axillary] lymph nodes, ipsilateral internal mammary lymph node[s] with axillary lymph nodes, or ipsilateral supraclavicular lymph nodes [N3])
Patients with 4 or more histologically positive axillary nodes if axillary dissection is performed
Patients must not have any palpable or radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes unless there is histologic confirmation that these nodes are negative for tumor
4 or more axillary lymph nodes involved with cancer
Axillary lymph nodes negative by pre-operative physical examination in all cases and pathologic examination from surgery for invasive disease
Clinically or pathologically positive axillary lymph nodes
Definitive evidence of metastatic disease with exception of axillary lymph nodes or mammary nodes
Metastatic breast cancer (local spread to axillary lymph nodes is permitted).
No evidence of disease outside the breast or chest wall, except ipsilateral axillary lymph nodes
No evidence of disease outside the breast or chest wall, except ipsilateral axillary or internal mammary lymph nodes
Planned for bilateral axillary surgery
Status post mastectomy with surgical assessment of axillary nodes
If PMRT is recommended, the treatment fields will include the axillary, supraclavicular, and internal mammary nodes
Participants undergoing preoperative systemic therapy must have residual invasive disease in the breast or axillary lymph nodes at the time of definitive surgery
Treatment with total mastectomy and axillary dissection; or breast-sparing surgical removal of cancer with clear macroscopic margins and axillary dissection; followed by adjuvant breast radiation
Patients with persistent palpable axillary nodes after NAC, as assessed by physical exam
Prior surgical axillary procedure including SLND or axillary node excision
CHILD: If applicable, willingness of the patient to shave axillary (armpit) hair
Patient must have a negative (normal) axillary ultrasound performed at Siteman Cancer Center; lymph nodes will be evaluated based on morphologic features; axillary ultrasound (AUS) will be considered positive (abnormal) if lymph nodes are noted to be completely hypoechoic (absent hilum) or to have focal hypoechoic cortical thickening/lobulation greater than 4 mm
No abnormal axillary nodes identified on grayscale axillary ultrasound (AUS), or abnormal nodes with benign subsequent FNA biopsy