Prospective Study Supports Omitting Axillary Staging in Selected Patients With Early Breast Cancer

A prospective study published in Annals of Surgery evaluated implementation of sentinel lymph node biopsy (SLNB) omission following the SOUND, INSEMA, and BOOG 13-08 trials. Between March 2024 and September 2025, investigators omitted SLNB in postmenopausal women aged 50–70 years undergoing breast-conserving surgery for clinical stage 1, grade 1–2, hormone receptor–positive, HER2-negative cancers with normal axillary ultrasound. Eligibility expanded to tumors up to 2.5 cm after INSEMA results were reported.

The cohort included 437 patients with 442 cancers; median age was 63 years and median mammographic tumor size was 0.9 cm. Final pathology identified high-risk features in 34 patients (8%), prompting multidisciplinary consideration of SLNB. Fourteen patients (3.2%) underwent SLNB, and two had sentinel node metastases. Radiotherapy was administered to 96%, endocrine therapy to 95%, and chemotherapy to 7%. No axillary recurrences were observed at a median follow-up of 7.7 months.

These findings support the practical feasibility of omitting SLNB in a carefully selected population, with approximately 97% avoiding the procedure. However, this observational implementation study does not establish comparative efficacy or long-term safety. Its short follow-up, restricted eligibility, and high use of adjuvant radiotherapy and endocrine therapy should inform interpretation.