Ongoing debate: Surgical staging of the axilla for invasive breast cancer

Sara B Cartwright; Stephen F Sener

doi:10.1016/j.amjsurg.2025.116671

Ongoing debate: Surgical staging of the axilla for invasive breast cancer

Am J Surg. 2026 Jan:251:116671. doi: 10.1016/j.amjsurg.2025.116671. Epub 2025 Oct 21.

Authors

Sara B Cartwright¹, Stephen F Sener²

Affiliations

¹ University of Southern California Breast Surgical Oncology Fellowship, Los Angeles, CA, USA; Department of Surgery, Surgical Oncology Service, Los Angeles General Medical Center, Los Angeles, CA, USA; Department of Surgery and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
² Department of Surgery, Surgical Oncology Service, Los Angeles General Medical Center, Los Angeles, CA, USA; Department of Surgery and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA. Electronic address: stephen.sener@med.usc.edu.

PMID: 41160943
DOI: 10.1016/j.amjsurg.2025.116671

Abstract

Sentinel lymph node biopsy (SLNB) may be safely omitted for patients ≥50 years of age with low-risk estrogen-receptor-positive cancers who have a negative pre-treatment axillary ultrasound. Surgical staging should still be done for patients who are premenopausal, postmenopausal with high-risk estrogen receptor-positive cancers when considering adjuvant CDK inhibitors, for those having neoadjuvant chemotherapy, or those with estrogen receptor-negative or human epidermal growth factor receptor-positive cancers. Approximately 2-6 % of patients with T1mi or T1a tumors have histologically positive lymph node status, so clinical and pathologic features can be used when deciding whether to employ SLNB in individual patients. For patients with cT1-2N0 breast cancer and an image-detected histologically positive axillary lymph node, SLNB is associated with avoidance of completion ALND in more than 70 % of patients.

Keywords: Breast cancer; Sentinel lymph node biopsy (SLNB); Sentinel lymphadenectomy (SLND); Surgical staging axilla invasive breast cancer.

Publication types

Review

MeSH terms

Axilla
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Humans
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Sentinel Lymph Node Biopsy