Axillary Recurrence and Survival After Omission of Axillary Lymph Node Dissection in Patients with Breast Cancer and Micrometastases or Isolated Tumor Cells in the Sentinel Node: A Danish National Register Study.

Authors

Riazan Heidari Rosenlund Korsholm, Niels Kroman, Tove F Tvedskov, Frederikke Munck

Published in

Annals of surgical oncology. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Completion axillary lymph node dissection (ALND) is no longer routinely recommended for patients with breast cancer and minimal nodal involvement. In 2012, Danish national guidelines were revised to omit ALND for patients with sentinel node (SN) micrometastases (pN1mi) or isolated tumor cells (pN0[i+]). Long-term evidence on axillary recurrence (AR) and overall survival (OS), particularly after mastectomy, remain limited. This nationwide retrospective register-based study evaluated long-term outcomes after omission of ALND.
Clinically node-negative women with pN1mi/pN0(i+) diagnosed between 2008 and 2021 were identified in the Danish Breast Cancer Group database. Patients treated before 2012 (ALND group) were compared with those treated after guideline revision in 2012 (no-ALND group). Both groups were compared with node-negative patients (pN0) treated after 2012. The primary endpoint was AR, and the secondary endpoint was OS. Survival was analyzed using Kaplan-Meier and multivariable Cox regression.
Among 22,253 eligible patients, 5066 had pN1mi/pN0(i+). The median follow-up period was 6.4 years. Axillary recurrence occurred for 1.1% of the patients overall and was more frequent among the patients without ALND than among those with ALND (1.5% vs 0.2%; p < 0.001). Among the pN0 patients without ALND, 0.5% experienced AR. Long-term OS for the pN1mi/pN0(i+) patients was 81.3% (95% confidence interval, 79.9-82.7), with no significant difference after adjustment for prognostic factors (p = 0.6). Mastectomy-specific analysis showed no difference in OS (p = 0.08).
Omission of ALND for patients with minimal SN involvement was associated with a slightly higher rate of AR but no adverse impact on long-term OS. These findings support continued de-escalation of axillary surgery, even for selected patients undergoing mastectomy.

PMID:
42406208
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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