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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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Oncological outcomes with and without axillary lymph node dissection in patients with residual micrometastases after neoadjuvant chemotherapy (OPBC-07/microNAC): an international, retrospective cohort study.

The Lancet. Oncology·2025
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Impact of bilateral surgery on time to treatment in patients with breast cancer undergoing mastectomy - a retrospective cohort study.

BMC cancer·2025
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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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Post-mastectomy radiotherapy negatively impacts short-term patient-reported outcomes in patients with and without immediate breast reconstruction - a retrospective cohort study.

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Axillary surgery in node-positive breast cancer.

Nadia Maggi1, Rahel Nussbaumer1, Liezl Holzer2

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

Breast (Edinburgh, Scotland)
|September 13, 2021
PubMed
Summary

Omitting axillary dissection is safe for select breast cancer patients with positive sentinel nodes. Research is expanding eligibility criteria for less invasive axillary surgery in both early and pre-treated settings.

Keywords:
Axillary dissectionAxillary stagingBreast cancerBreast surgerySentinel lymph node procedure

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Long-term data support omitting axillary dissection in node-negative, sentinel node-positive breast cancer.
  • Current de-escalation of axillary surgery is limited, primarily to the neoadjuvant setting for node-positive patients.
  • Targeted axillary dissection shows promise in reducing false-negative rates for sentinel procedures.

Purpose of the Study:

  • To review the safety and evolving role of axillary surgery de-escalation in breast cancer.
  • To explore the potential of tailored axillary surgery in both adjuvant and neoadjuvant settings.
  • To discuss the current limitations and ongoing investigations in axillary staging.

Main Methods:

  • Review of long-term follow-up data from multicenter phase III non-inferiority trials.
  • Analysis of ongoing clinical trials investigating extended eligibility for axillary surgery omission.
  • Examination of single-center series on sentinel procedure outcomes and targeted axillary dissection.

Main Results:

  • Confirmed safety of omitting axillary dissection in specific node-positive breast cancer cohorts.
  • Sentinel procedures show a consistently low risk of axillary recurrence.
  • Axillary dissection remains standard for residual disease post-neoadjuvant chemotherapy pending trial results.

Conclusions:

  • Axillary surgery de-escalation is progressing, with ongoing trials expanding patient eligibility.
  • Tailored axillary surgery represents a novel approach for selective node removal.
  • Further research, including the TAXIS trial, will refine axillary management strategies.