[Evidence-based evolution and clinical considerations of de-escalation in axillary surgery for early breast cancer]

In recent years, with the publication of multiple prospective randomized controlled trials, abundant evidence-based data have accumulated for axillary management in early breast cancer, and the concept of axillary de-escalation therapy has been widely recognized. Clinical strategies have evolved from the traditional invasive axillary lymph node dissection to minimally invasive sentinel lymph node biopsy, and further to precise individualized treatment with axillary surgery omission (non-invasive management). Such approaches maintain therapeutic efficacy, reduce postoperative complications and improve patients' quality of life. This paper systematically reviews landmark clinical trials in this field and thoroughly interprets their core findings. Integrating the latest evidence-based data and clinical practical experience, it discusses the core controversies, key clinical implementation considerations and future prospects of axillary de-escalation therapy, so as to provide references for clinical decision-making.