Soumen Das, Head of Department of Surgical Oncology at Netaji Subhas Chandra Bose Cancer Hospital, CEO and Co-Founder at ArrowsUP LLP, and Co-Founder at Specifixon Healthcare, shared a post on LinkedIn:
“Axillary de-escalation continues to redefine modern breast cancer surgery.
A recently published prospective multicenter trial in JAMA Surgery evaluated upfront Sentinel Lymph Node Biopsy (SLNB) in carefully selected patients with cN1 HR+/HER2− breast cancer and palpable axillary disease. The study demonstrated that nearly 70% of patients could avoid Axillary Lymph Node Dissection (ALND) with no early isolated axillary or locoregional recurrences reported.
This is undoubtedly an important and provocative study.
The concept is attractive:
Less morbidity.
Less lymphedema.
Less functional impairment.
Better quality of life.
However, several scientific concerns remain before widespread adoption:
- The study is a feasibility trial — not a non-inferiority oncologic trial.
- Median follow-up of 25 months is short for HR+/HER2− disease biology.
- Despite careful ultrasound selection, 31% still had ≥3 positive nodes.
- One-third of metastatic palpable nodes were neither radioactive nor blue intraoperatively, potentially raising false-negative concerns in non-expert settings.
- Results are heavily influenced by modern systemic therapy and regional nodal irradiation.
- Reproducibility outside high-volume specialist breast centres remains uncertain.
Perhaps the most important question is:
Are we truly proving that ALND is unnecessary in this subgroup — or are we increasingly relying on systemic therapy and radiation to compensate for residual axillary disease?
Nevertheless, this study is a landmark step in challenging traditional surgical dogma and pushing the breast oncology community toward more biology-driven and patient-centered care.
Long-term data from TAXIS and future randomized studies will be crucial before redefining standards globally.”
Title: Sentinel Lymph Node Biopsy for Patients With cN1 HR+/HER2− Breast Cancer and Palpable Adenopathy
Authors: Anita Mamtani, Melissa Pilewskie, Niamey Wilson, Heiwon Whang, Andrea Barrio, Leah Bassin, Deborah Capko, Daniel Choi, Hiram Cody, Stephanie Downs-Canner, Mahmoud El-Tamer, Mary Gemignani, Alexandra Heerdt, Laurie Kirstein, Minna Lee, Victoria Mango, Giacomo Montagna, Tracy-Ann Moo, Jacqueline Oxenberg, George Plitas, Michael Sabel, Virgilio Sacchini, Lisa Sclafani, Varadan Sevilimedu, Audree Tadros, Kimberly Van Zee, Monica Morrow
Read the Full Article on JAMA Surgery
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