De-escalation treatment of axilla in breast cancer

Excerpt

In cases of negative axillary staging, axillary lymph node dissection (ALND) has been replaced by sentinel node (SN) biopsy as the standard treatment for BC. ALND following a positive SN biopsy is being progressively abandoned. Results from the latest 10 years, phase 3 trial (IBCSG 23-01) confirmed that if the SN displays only micrometastases, then ALND is not indicated [1]. However, ALND is routinely performed in cases of macrometastatic SN biopsy, in particular after mastectomy. In breast-conserving surgery (BCS), results from the ACOSOG Z0011 trial contraindicated ALND if only one to two SNs are positive. ALND is still recommended if ≥ 3 SNs contain metastases or macroscopic lymph node is found intraoperatively [2]. …