Axillary observation alone versus sentinel node biopsy: past, present and future perspectives.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Axillary surgery for breast cancer has evolved from complete axillary dissection to sentinel node biopsy.
• There is a trend towards de-escalation and axillary conservation in surgical procedures.
• The roles of therapeutic and staging procedures in axillary surgery have diminished, with other modalities gaining prominence.

Purpose of the Study:

• To review the evolution of axillary surgery in breast cancer, focusing on the trend towards de-escalation.
• To explore the concept and evidence for omitting axillary surgery in selected breast cancer patients.
• To present historical and ongoing research on axillary observation as an alternative to surgical staging.

Main Methods:

• Qualitative review of relevant literature.
• Analysis of historical trials on axillary surgery omission.
• Examination of current and ongoing clinical trials investigating axillary observation.

Main Results:

• Historical data suggests no survival impact from omitting axillary treatment in some cases.
• Ongoing trials aim to validate "axillary observation" as equivalent to sentinel node biopsy in specific cohorts.
• Advancements in systemic treatments, radiotherapy, and diagnostics are supporting the de-escalation of axillary surgery.

Conclusions:

• Axillary surgery in breast cancer is progressively de-escalating, moving towards conservation.
• The omission of axillary surgery is being investigated as a viable option for selected patients.
• Future research will identify patient subgroups for whom axillary surgery is no longer necessary, supported by advancements in non-surgical modalities.