REVIEW article
Front. Surg.
Sec. Surgical Oncology
Lymph Node Management in Early-Stage Breast Cancer: Balancing Oncological Safety and Treatment De-escalation
Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China, Zhenjiang, China
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Abstract
Axillary lymph node management represents one of the most dynamic areas in breast cancer surgery, having undergone a dramatic paradigm shift from routine radical dissection to selective, risk-adapted approaches over the past three decades. This evolution has been driven by improved understanding of breast cancer biology, advances in systemic therapy, and accumulating high-quality evidence from prospective randomized trials. Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as the standard staging procedure for clinically node-negative patients, significantly reducing surgical morbidity without compromising survival. More recently, landmark trials including ACOSOG Z0011, AMAROS, and SENOMAC have demonstrated that completion ALND can be safely omitted in selected patients with limited sentinel node metastases, further minimizing treatment-related complications while maintaining excellent regional control. However, important controversies persist regarding optimal management in the neoadjuvant setting, the role of preoperative axillary imaging, appropriate patient selection for surgical de-escalation, and how molecular tumor characteristics should inform axillary treatment decisions. Emerging technologies including liquid biopsy, artificial intelligence-enhanced imaging, and molecular profiling promise to further refine patient selection and may eventually enable non-invasive nodal staging in selected populations. This review synthesizes current evidence on axillary management strategies, critically examines ongoing controversies, and explores future directions that may transform the approach to regional disease assessment and treatment in early-stage breast cancer.
Summary
Keywords
breast cancer, early-stage, Lymph node management, oncological safety, Treatment
Received
22 November 2025
Accepted
17 February 2026
Copyright
© 2026 Ling and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhenhua Sun
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