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<p>Landmark trials have shown that axillary lymph node dissection (ALND) can be safely omitted in early breast cancer patients with 1–2 positive nodes. Despite lack of prospective data, the National Comprehensive Cancer Network (NCCN) guidelines recommend that patients with 1–2 suspicious or biopsy-proven positive lymph nodes having primary surgery can undergo sentinel lymph node biopsy (SLNB). In the era of de-escalation of axillary surgery, breast cancer management in patients with clinically node-positive (cN +) axilla is driven by tumour biology and response to neoadjuvant chemotherapy (NACT). In this review, we discuss the management of the axilla in early breast cancer patients with low-volume biopsy-proven nodal disease and summarise the evidence supporting omission of ALND in these patients undergoing primary surgery.</p>

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De-escalating axillary surgery in node-positive early breast cancer patients undergoing primary surgery: current evidence and recommendations

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月22日

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  • Hussain Abdulla,
  • Eman Hamza,
  • Maha Alsendi

摘要

Landmark trials have shown that axillary lymph node dissection (ALND) can be safely omitted in early breast cancer patients with 1–2 positive nodes. Despite lack of prospective data, the National Comprehensive Cancer Network (NCCN) guidelines recommend that patients with 1–2 suspicious or biopsy-proven positive lymph nodes having primary surgery can undergo sentinel lymph node biopsy (SLNB). In the era of de-escalation of axillary surgery, breast cancer management in patients with clinically node-positive (cN +) axilla is driven by tumour biology and response to neoadjuvant chemotherapy (NACT). In this review, we discuss the management of the axilla in early breast cancer patients with low-volume biopsy-proven nodal disease and summarise the evidence supporting omission of ALND in these patients undergoing primary surgery.