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Purpose of Review <p> The sentinel lymph node biopsy (SLNB) has become standard over axillary lymph node dissection (ALND) in clinically node-negative breast cancer. With continued advances in axillary management, further de-escalation is possible. This review examines de-escalation of axillary surgery in specific populations.</p> Recent Findings <p>Patients ≥70 with early-stage estrogen-positive, HER-2 negative breast cancer can omit axillary staging without differences in overall survival. The SOUND and INSEMA trials allow for omission of axillary staging if tumors are ≤2cm and negative axillary ultrasound if no effect on adjuvant therapies. Consider using SPIO for delayed sentinel node biopsy if undergoing mastectomy for DCIS. Finally, SLNB, using specific techniques, is a viable staging method after neoadjuvant systemic therapy.</p> Summary <p>With the rise of SLNB over ALND, specific patient populations are amenable to further de-escalation. Age ≥70, negative preoperative axillary ultrasound, and those undergoing mastectomy for DCIS are all cohorts where omission of axillary surgery is possible.</p>

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Making our Way out of the Axilla: A Look at De-Escalation in Axillary Therapy

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Angela Pallesi,
  • Javier I. J. Orozco,
  • Brian Diskin,
  • Laurel Sorensen,
  • Nicketti Handy,
  • Janie G. Grumley,
  • Crystal E. Fancher

摘要

Purpose of Review

The sentinel lymph node biopsy (SLNB) has become standard over axillary lymph node dissection (ALND) in clinically node-negative breast cancer. With continued advances in axillary management, further de-escalation is possible. This review examines de-escalation of axillary surgery in specific populations.

Recent Findings

Patients ≥70 with early-stage estrogen-positive, HER-2 negative breast cancer can omit axillary staging without differences in overall survival. The SOUND and INSEMA trials allow for omission of axillary staging if tumors are ≤2cm and negative axillary ultrasound if no effect on adjuvant therapies. Consider using SPIO for delayed sentinel node biopsy if undergoing mastectomy for DCIS. Finally, SLNB, using specific techniques, is a viable staging method after neoadjuvant systemic therapy.

Summary

With the rise of SLNB over ALND, specific patient populations are amenable to further de-escalation. Age ≥70, negative preoperative axillary ultrasound, and those undergoing mastectomy for DCIS are all cohorts where omission of axillary surgery is possible.