Authors
P F Qiu, X W Wang, Y S Wang
Published in
Zhonghua yi xue za zhi. Volume 106. Issue 26. Pages 2650-2655. Jul 21, 2026.
Abstract
Neoadjuvant therapy (NAT) has strengthened systemic control in breast cancer and promoted precision de-escalation of axillary management. For clinically node-negative patients, evidence supports sentinel lymph node biopsy (SLNB) after NAT; among human epidermal growth factor receptor 2(HER2)-positive and triple-negative breast cancer patients achieving breast pathological complete response, the risk of residual axillary metastasis is extremely low, suggesting the potential omission of axillary surgery. For clinically node-positive patients converting to node-negative (cN1➝ycN0) after NAT, targeted axillary dissection can reduce the false-negative rate of SLNB to 2%-4% with good local control, supporting SLNB as a substitute for axillary lymph node dissection. In patients with low-volume residual nodal disease, axillary radiotherapy is increasingly considered as an alternative to surgery, though long-term evidence is still required. With studies such as NSABP B-51 demonstrating reduced regional irradiation in selected patients, dual de-escalation of surgery and radiotherapy has become a research focus. Future advances in imaging, artificial intelligence, and circulating tumor DNA (ctDNA) may enable individualized axillary decision-making.
PMID:
42477935
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.
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