{"title":"Updates in Surgical Management of the Axilla.","authors":"Anita Mamtani, Andrea V Barrio","doi":"10.46883/2025.25921035","DOIUrl":null,"url":null,"abstract":"<p><p>Over the past 3 decades, axillary management in patients with breast cancer has evolved dramatically. The introduction and increasing use of sentinel lymph node biopsy (SLNB) have revolutionized the surgical approach for many patients with early breast cancer, permitting appropriate axillary staging without compromising prognosis and conferring significantly less morbidity than axillary lymph node dissection (ALND). For patients with clinically node-negative breast cancer and pathologically negative nodes or limited nodal metastases who have up-front surgery followed by radiotherapy, SLNB alone is now the standard of care, as it is for many patients who are clinically node positive and achieve a nodal pathologic complete response to neoadjuvant therapy. Omission of SLNB is also becoming possible for many patients with early-stage hormone receptor-positive/HER2-negative clinically node-negative breast cancer, with a large randomized trial demonstrating noninferiority of omission of axillary surgery to SLNB. Conversely, for those with residual nodal disease after neoadjuvant chemotherapy or those with a clinically positive axilla who have up-front surgery, ALND remains indicated, although clinical trials evaluating de-escalation of axillary surgery in these patient subsets are ongoing. As multidisciplinary treatment paradigms become increasingly nuanced, it is crucial that systemic therapy treatment decisions for patients with early-stage breast cancer be based on the available pathologic nodal status provided by SLNB, without the need for ALND to find additional positive nodes. Here we review recent advances and ongoing controversies in the modern surgical management of the axilla in breast cancer.</p>","PeriodicalId":51147,"journal":{"name":"Oncology-New York","volume":"39 2","pages":"70-75"},"PeriodicalIF":1.8000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oncology-New York","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.46883/2025.25921035","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Over the past 3 decades, axillary management in patients with breast cancer has evolved dramatically. The introduction and increasing use of sentinel lymph node biopsy (SLNB) have revolutionized the surgical approach for many patients with early breast cancer, permitting appropriate axillary staging without compromising prognosis and conferring significantly less morbidity than axillary lymph node dissection (ALND). For patients with clinically node-negative breast cancer and pathologically negative nodes or limited nodal metastases who have up-front surgery followed by radiotherapy, SLNB alone is now the standard of care, as it is for many patients who are clinically node positive and achieve a nodal pathologic complete response to neoadjuvant therapy. Omission of SLNB is also becoming possible for many patients with early-stage hormone receptor-positive/HER2-negative clinically node-negative breast cancer, with a large randomized trial demonstrating noninferiority of omission of axillary surgery to SLNB. Conversely, for those with residual nodal disease after neoadjuvant chemotherapy or those with a clinically positive axilla who have up-front surgery, ALND remains indicated, although clinical trials evaluating de-escalation of axillary surgery in these patient subsets are ongoing. As multidisciplinary treatment paradigms become increasingly nuanced, it is crucial that systemic therapy treatment decisions for patients with early-stage breast cancer be based on the available pathologic nodal status provided by SLNB, without the need for ALND to find additional positive nodes. Here we review recent advances and ongoing controversies in the modern surgical management of the axilla in breast cancer.
期刊介绍:
Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.