ASO Author Reflections: De-escalating Axillary Surgery in Patients with Clinically Node-Negative Breast Cancer After Neoadjuvant Chemotherapy

Sentinel lymph node biopsy has been established as the standard for axillary staging in patients with early-stage breast cancer undergoing upfront surgery. In patients presenting with clinical node-negative (cN0) disease treated with neoadjuvant chemotherapy, sentinel lymph node biopsy has also become the accepted approach to axillary staging after systemic therapy. While clinical trials have demonstrated the oncologic safety of omitting axillary lymph node dissection in patients with a limited number of positive sentinel lymph nodes (SLNs) treated with upfront surgery, it is unknown whether these data can be extrapolated to patients with cN0 axilla who have positive sentinel nodes after neoadjuvant systemic therapy.^1‐3 The rate of axillary recurrence in these patients with low-volume SLN disease following neoadjuvant chemotherapy in whom axillary dissection (ALND) is omitted is not known and it is unclear how omission of ALND may impact adjuvant therapy decisions. Therefore, ALND remains the standard of care in these patients. …