Evolution in the Management of Axillary Lymph Nodes in Breast Cancer

As individuals with breast cancer are presenting at earlier stages of disease and with greater biologic characterization, the surgical approaches have progressively de-escalated. In the mid-1900s, radical mastectomy was replaced with modified radical surgery and decreased utilization of level 3 nodal removal. By the early 2000s, sentinel lymph node surgery had replaced axillary dissection for early-stage disease and eventually those that underwent neoadjuvant therapy to downstage their tumors. In the 2020s, de-escalation of axillary surgery to subgroups that no longer require nodal evaluation will continue due to the lack of impact on treatment course.