Optimizing axillary surgery for patients with clinically node-negative and node-positive breast cancer.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Sentinel lymph node biopsy (SLNB) has become standard for early breast cancer, prompting de-escalation strategies for axillary surgery.
• Randomized trials indicate that for specific early breast cancer cohorts (e.g., older women, luminal subtype, small tumors), omitting axillary surgery is non-inferior to SLNB regarding recurrence and metastasis.

Purpose of the Study:

• To review and optimize axillary surgery de-escalation for early breast cancer patients.
• To discuss tailored axillary surgery approaches for node-positive breast cancer treated with neoadjuvant chemotherapy.
• To present findings from randomized trials and institutional experiences to guide personalized axillary management.

Main Methods:

• Review of randomized trials comparing axillary surgery versus SLNB in early breast cancer.
• Analysis of tailored axillary surgery strategies in node-positive breast cancer patients receiving neoadjuvant chemotherapy.
• Evaluation of image-guided localization techniques (e.g., clipping) for lymph node assessment.

Main Results:

• For specific node-negative early breast cancer patients (age ≥50, small luminal tumors), no axillary surgery demonstrated non-inferiority to SLNB.
• Image-guided localization improves accuracy in diagnosing lymph node involvement and reduces SLNB false negatives.
• Image-guided techniques can decrease regional lymph node recurrence, often in conjunction with radiation and adjuvant therapies.

Conclusions:

• Axillary surgery de-escalation is feasible and effective for select early breast cancer patients.
• Image-guided localization is a valuable tool for optimizing axillary staging and management.
• Personalized axillary surgery strategies are essential for both node-negative and node-positive early breast cancer.