What question did this study set out to answer?

The aim is to review changes in surgical standards for axillary management in breast cancer and evaluate recent trial findings.

April 3, 2026memo - Magazine of European Medical Oncology1 citationsOpen Access

Current surgical standards in the management of the axilla

KWKerstin WimmerKarolinska Institutet FFFlorian FitzalHanusch Hospital

Key Points

The aim is to review changes in surgical standards for axillary management in breast cancer and evaluate recent trial findings.
Reviewed literature on axillary surgery and changes over the decades.
Summarized findings from the INSEMA, SOUND, and BOOG 13-08 trials.
Discussed implications and limitations of current standards.
Lymph node dissection was the standard until around the 1990s, with high morbidity rates.
Sentinel lymph node biopsy is now commonly used to reduce complications.
Recent evidence suggests that SLNB can potentially be omitted in selected low-risk patients.

Abstract

Summary 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.

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