Sentinel Node Biopsy Reduces Axillary Dissection in cN1 Breast Cancer

The management of the axilla in early-stage breast cancer has shifted significantly toward de-escalation to minimize the high morbidity associated with complete axillary lymph node dissection [1, 2]. While omitting axillary dissection is now standard for clinically node-negative patients with limited sentinel lymph node involvement, those presenting with palpable adenopathy have historically been excluded from these conservative protocols [3, 4]. Complete dissection remains the default for these patients, despite its well-documented risks of lymphedema, sensory loss, and reduced range of motion [5, 6]. Recent meta-analyses suggest that survival outcomes may not be compromised by less invasive approaches in select populations, yet clinicians lack prospective data for those with palpable disease [7, 8]. A new study now evaluates whether upfront sentinel lymph node biopsy can be successfully applied to this higher-risk cohort to further reduce surgical overtreatment.