Omission of Axillary Surgery in Early-Stage Breast Cancer: Implications for Multidisciplinary Decision-Making

Abstract Purpose of Review To examine how omission of axillary surgery in early-stage breast cancer influences systemic therapy and radiation decision-making as treatment paradigms shift toward biologic rather than anatomic risk. Recent Findings The SOUND and INSEMA trials demonstrated that sentinel lymph node biopsy can be safely omitted in selected patients with early-stage, hormone receptor–positive, HER2-negative, clinically node-negative disease and negative axillary ultrasound findings. These findings have redefined multidisciplinary treatment planning, prompting new challenges in systemic therapy selection, radiation field design, and trial eligibility in the absence of nodal data. Summary Omission of axillary surgery requires thoughtful multidisciplinary coordination and integration of patient preferences to ensure oncologic safety. Future studies should evaluate concurrent surgical, systemic, and radiation de-escalation to establish evidence-based pathways that right-size care across diverse practice settings.