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From Axillary Lymph Node Dissection to Sentinel Node Biopsy in Breast Cancer: A 23-Year Population-Based Large-Sample
Lucia Mangone1, Francesco Marinelli1, Isabella Bisceglia1
1Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Breast Cancer (Dove Medical Press)
|April 23, 2026
Summary
Breast cancer axillary surgery is shifting towards less invasive methods like sentinel lymph node biopsy (SLNB), showing improved survival rates compared to axillary lymph node dissection (ALND). This trend reflects real-world practice and clinical trial evidence.
Area of Science:
- Oncology
- Surgical Oncology
- Public Health
Background:
- Axillary surgery for breast cancer has evolved towards less invasive techniques.
- Understanding long-term trends in axillary management is crucial for patient outcomes.
Purpose of the Study:
- To assess long-term trends in axillary management for invasive breast cancer.
- To evaluate the shift from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB).
Main Methods:
- Population-based study analyzing 10,955 women with invasive breast cancer (2000-2022).
- Data collected in Reggio Emilia, Italy.
- Assessed trends in ALND and SLNB utilization and overall survival.
Main Results:
- Significant decline in ALND from 47.9% to 18.1%; parallel increase in SLNB from 43.8% to 74.7%.
- The shift was most prominent in stage I tumors, with ALND dropping from 44.7% to 2.9%.
- 15-year overall survival was higher in the SLNB group (78%) vs. ALND group (72%).
Conclusions:
- Conservative axillary approaches (SLNB) are safe and effective in real-world practice.
- Findings support the applicability of major clinical trial results in unselected populations.
- Further research needed on quality of life, radiotherapy, and tumor biology impacts.
