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Letter to the Editor Regarding Abdulla, H.A., et al. "Oncologic Outcomes of Sentinel Lymph Node Biopsy Versus Targeted Axillary Dissection for Node-Positive Breast Cancer Patients After Neoadjuvant Chemotherapy: A Systematic Review and Meta-analysis".

Annals of surgical oncology·2026
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ALND after neoadjuvant chemotherapy: a call for caution - Authors' reply.

The Lancet. Oncology·2026
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Impact of bilateral surgery on time to treatment in patients with breast cancer undergoing mastectomy - a retrospective cohort study.

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Omission of sentinel lymph node biopsy in early stage luminal breast cancer: impact on adjuvant CDK4/6 inhibitor recommendation and oncological outcomes.

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Related Experiment Video

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Murine Superficial Lymph Node Surgery
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Lymph Node Surgery - Stepwise Retirement for the Breast Surgeon?

Julia Landin1, Walter P Weber1

  • 1Breast Center, University Hospital of Basel, Basel, Switzerland.

Breast Care (Basel, Switzerland)
|October 11, 2016
PubMed
Summary

Breast cancer surgery is shifting away from axillary lymph node dissection (ALND). While less axillary surgery is favored, regional nodal irradiation is expanding, creating conflicting treatment trends.

Keywords:
Breast cancerLymph node dissectionSentinel lymph node

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiotherapy Oncology

Background:

  • Axillary lymph node dissection (ALND) was the standard for breast cancer staging until the 1990s.
  • The advent of sentinel lymph node biopsy (SLNB) initiated a trend towards less invasive axillary staging.
  • Current evidence supports omitting ALND even in cases with positive lymph nodes, with ongoing trials refining indications.

Purpose of the Study:

  • To review the conflicting evidence regarding axillary lymph node management in breast cancer.
  • To present ongoing clinical trials evaluating the role of ALND.
  • To discuss optimal current and future regional management strategies for breast cancer patients with affected lymph nodes.

Main Methods:

  • Literature review of evidence-based clinical trends and randomized controlled trials.
  • Analysis of data on the evolving indications for ALND.
  • Examination of current practices and evidence for regional nodal irradiation.

Main Results:

  • A significant trend exists towards reducing or omitting ALND in breast cancer management.
  • Concurrently, there is an expanding indication and extent for regional nodal irradiation, supported by trial data.
  • Conflicting evidence necessitates careful consideration of both surgical and radiation approaches.

Conclusions:

  • The optimal regional management for breast cancer patients with affected lymph nodes is complex and evolving.
  • Balancing the trend towards less axillary surgery with expanding nodal irradiation requires careful clinical judgment.
  • Ongoing trials are crucial for defining the future role of ALND and optimizing regional treatment strategies.