ReviewJournal of breast cancer2026
Axillary Surgery in Breast Cancer: Evidence-Based De-escalation Across Upfront and Post-Neoadjuvant Settings.
Review in Journal of breast cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed.
- Prospective comparison of [European journal of nuclear medicine and molecular imaging · 2026Trial
- Article
- Predicting preoperative axillary lymph node metastasis to guide surgical decisions in invasive breast cancer.Frontiers in oncology · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Axillary surgery in breast cancer has progressively shifted from radical clearance to selective de-escalation. Sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) as the standard, markedly reducing morbidity while maintaining oncologic safety. More recently, randomized trials have challenged even the necessity of SLNB in certain patients, reflecting a broader movement toward optimization rather than maximal intervention. Evidence can be grouped according to the burden of sentinel node metastasis. Micrometastasis-focused trials (IBCSG 23-01, AATRM) showed that omission of ALND in patients with one or more micrometastases (≤ 2 mm) did not compromise survival or locoregional control. Mixed-burden trials (ACOSOG Z0011, AMAROS) included patients with 1-2 positive sentinel lymph nodes, regardless of micrometastatic or macrometastatic size, and confirmed the safety of avoiding ALND when appropriate systemic therapy and radiotherapy are given. Macrometastasis trials (SENOMAC, SINODAR-ONE, POSNOC) extended these findings to patients with 1-2 macrometastases (≥ 2 mm), demonstrating that ALND omission is still safe even in higher-burden disease. In parallel, de-escalation has advanced further. SOUND and INSEMA established non-inferiority of observation vs. SLNB in clinically node-negative (cN0), imaging-negative tumors, while ongoing studies such as NAUTILUS are validating these results in Asian populations. In the neoadjuvant setting, SLNB is standard for cN0 patients and feasible in clinically node-positive patients who convert to cN0 after neoadjuvant chemotherapy. Ongoing trials (ASICS, EUBREAST-01, ASLAN) are exploring whether axillary surgery can be omitted entirely in excellent responders, particularly in human epidermal growth factor receptor 2-positive and triple-negative breast cancer. The collective data indicate a clear trend. Axillary surgery should be optimized to disease biology, systemic therapy response, and patient quality of life.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.