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<p>Axillary surgery in breast cancer has undergone a&#xa0;profound transformation in recent decades. While axillary lymph node dissection (ALND) was the unquestioned standard until the 1990s [<CitationRef CitationID="CR1">1</CitationRef>], associated morbidity including lymphedema rates as high as 25% in the affected arm [<CitationRef CitationID="CR2">2</CitationRef>], led to the widespread adoption of sentinel lymph node biopsy (SLNB). Recent data now suggest that even SLNB may be safely omitted in selected low-risk patients. This article reviews the evolution of axillary management, summarizes pivotal evidence from the INSEMA, SOUND and BOOG 13-08&#xa0;trials, and discusses the clinical implications, limitations, and future directions of this ongoing de-escalation process.</p>

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Current surgical standards in the management of the axilla

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月1日

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  • Kerstin Wimmer,
  • Florian Fitzal

摘要

Axillary surgery in breast cancer has undergone a profound transformation in recent decades. While axillary lymph node dissection (ALND) was the unquestioned standard until the 1990s [1], associated morbidity including lymphedema rates as high as 25% in the affected arm [2], led to the widespread adoption of sentinel lymph node biopsy (SLNB). Recent data now suggest that even SLNB may be safely omitted in selected low-risk patients. This article reviews the evolution of axillary management, summarizes pivotal evidence from the INSEMA, SOUND and BOOG 13-08 trials, and discusses the clinical implications, limitations, and future directions of this ongoing de-escalation process.