Fig. 2

Clinical trials of axillary management in patients with breast cancer. Axillary lymph node status was routinely assessed by axillary lymph node dissection (ALND), which can provide information for staging and achieving regional control. Several clinical trials have been performed to determine whether ALND can be safely omitted and whether sentinel lymph node biopsy (SLNB) may serve as an alternative for ALND. For early-stage breast cancer patients, ALND could be avoided without significantly affecting locoregional recurrence or long-term survival. For T1-2 breast cancer patients with no palpable lymphadenopathy and a positive sentinel lymph node, axillary radiotherapy presents comparable axillary control and less morbidity. For patients who receive neoadjuvant chemotherapy (NAC) before axillary surgery, SLNB is acceptable in initially cN1/2 patients who become cN0 after NAC. There is a growing trend toward minimally invasive approaches and fewer postoperative complications in axillary surgery. ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy; RT, radiotherapy; pN + , pathologically node-positive; DFS, disease-free survival; OS, overall survival; TAD, targeted axillary dissection; cN0, clinically node-negative; cN1/2, clinically node-positive; NAC, neoadjuvant chemotherapy. Created with BioRender.com