Axillary Dissection — The Bell Tolls for Thee

This editorial traces the decline of axillary lymph node dissection in breast cancer management. Once the gold standard for axillary staging, it has been largely replaced by sentinel node biopsy, supported by trials such as ACOSOG Z0011, AMAROS, and now SENOMAC. These studies show no survival or recurrence benefit from full dissection in patients with limited nodal disease. The piece also discusses evolving practices in neoadjuvant therapy, targeted axillary dissection, and the SOUND trial, which questions the necessity of any axillary surgery in certain early stage cases. The author emphasizes that while axillary dissection is fading, axillary staging remains crucial for guiding treatment decisions.

This editorial traces the decline of axillary lymph node dissection in breast cancer management. Once the gold standard for axillary staging, it has been largely replaced by sentinel node biopsy, supported by trials such as ACOSOG Z0011, AMAROS, and now SENOMAC. These studies show no survival or recurrence benefit from full dissection in patients with limited nodal disease. The piece also discusses evolving practices in neoadjuvant therapy, targeted axillary dissection, and the SOUND trial, which questions the necessity of any axillary surgery in certain early stage cases. The author emphasizes that while axillary dissection is fading, axillary staging remains crucial for guiding treatment decisions.