Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“Axillary Lymph Node Dissection Is Not Routinely Indicated in Patients with Sentinel Lymph Node Residual Micrometastases Following Neoadjuvant Systemic Therapy
In this review article published today in the American Journal of Surgery, we concludethat nodal micrometastases found in the SLNs or TAD following NST are associated with a modest risk of residual nodal disease beyond the nodes examined. Routine ALND represents overtreatment in the context of modern multimodality care. Contemporary systemic therapies, ART, and the morbidity associated with ALND support a conservative, individualized approach. Completion ALND should be reserved for cases where the anticipated benefit outweighs risks. Emerging biomarkers, including circulating tumor DNA, may further refine patient selection, advancing precision de-escalation strategies in breast cancer care (22–24).
Future studies should evaluate whether axillary radiation and RNI can be safely omitted in patients with ypN1mi not undergoing cALND in the setting of contemporary systemic therapy. Ongoing trials, such as Alliance A011202, will provide higher-level evidence to guide optimal axillary management, potentially informing updates to NCCN, ASCO, AGO and ESMO guidelines. Until then, multidisciplinary evaluation remains essential, integrating tumor biology, systemic therapy response, planned radiotherapy, and patient preferences to optimize outcomes while minimizing unnecessary morbidity.”
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