Axillary de-escalation in early breast cancer: current evidence and clinical considerations

The need of sentinel lymph node biopsy (SLNB) in early-stage, clinically node-negative breast cancer is undergoing re-evaluation following evidence from recent non-inferiority trials. This review focuses on two key studies—SOUND and INSEMA, along with recent results from BOOG 2013–08—which investigated the safety of omitting SLNB in postmenopausal women with biologically favorable tumors undergoing breast-conserving surgery. The trials demonstrated very low axillary recurrence rates and no significant difference in survival outcomes between the SLNB and no-surgery arms, supporting selective omission of SLNB in low-risk patients. However, this approach raises important questions about the downstream impact on adjuvant therapy decisions. While omission of SLNB may reduce surgical morbidity, its broader implications on personalized treatment must be carefully considered. Multidisciplinary decision-making remains essential to ensure that oncologic safety is preserved while aligning treatment strategies with evolving evidence and patient-specific factors.