Ongoing debate: Surgical staging of the axilla for invasive breast cancer

Sentinel lymph node biopsy (SLNB) may be safely omitted for patients ≥50 years of age with low-risk estrogen-receptor-positive cancers who have a negative pre-treatment axillary ultrasound. Surgical staging should still be done for patients who are premenopausal, postmenopausal with high-risk estrogen receptor-positive cancers when considering adjuvant CDK inhibitors, for those having neoadjuvant chemotherapy, or those with estrogen receptor-negative or human epidermal growth factor receptor-positive cancers. Approximately 2-6 ​% of patients with T1mi or T1a tumors have histologically positive lymph node status, so clinical and pathologic features can be used when deciding whether to employ SLNB in individual patients. For patients with cT1-2N0 breast cancer and an image-detected histologically positive axillary lymph node, SLNB is associated with avoidance of completion ALND in more than 70 ​% of patients.