Department of Plastic and General Surgery, Turku University Hospital, University of Turku, Turku, Division of Breast Surgery, Comprehensive Cancer Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland Anselm Tamminen, Tuomo Meretoja cikkei

Since the introduction of radical breast and axillary surgery by William Halsted, breast cancer treatment—including nodal surgery—has gradually evolved toward more conser­vative approaches. This narrative review outlines the key steps in the de-escalation of axillary management, including the adoption of sentinel lymph node biopsy for clini­cally node-negative early breast cancer and later for larger tumors; the omission of completion axillary dissection in cases with minimal or limited macrometastatic sentinel lymph node involvement; the substitution of surgery with radiotherapy and systemic therapy, or omission in selected patients; and subsequent application in the neoadjuvant setting. Future directions in the de-escalation process are also outlined.

Magy Onkol 70:221-224, 2026