1168 – De-escalation of axillary management in breast cancer: analysis of real-life data from a mastology service

Authors

  • Stephani da Costa e Sousa Freire da Silva Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Giulia Severini Lazarini Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Fernanda Mayumi Tengan Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Rodrigo Macedo da Silva Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Vinicius Miranda Borges Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Carlos Elias Fristachi Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.
  • Fábio Francisco Oliveira Rodrigues Instituto de Câncer Dr. Arnaldo Vieira de Carvalho– São Paulo (SP), Brazil.

DOI:

https://doi.org/10.29289/259453942025V36S11168

Keywords:

breast cancer, sentinel lymph node, axillary dissection, surgical de-escalation, real-world data

Abstract

Introduction: Axillary surgical management in breast cancer has evolved towards de-escalation. The ACOSOG Z0011
trial demonstrated that, in patients with early breast cancer and positive sentinel lymph node biopsy (SLNB) undergoing
breast-conserving surgery, SLNB alone is non-inferior to axillary lymphadenectomy (ALND) in terms of overall survival
and 10-year recurrence, with lower morbidity, and the SENOMAC randomized clinical trial has expanded this concept.
Recently, studies have shown that omitting SLNB, even in locally advanced tumors, can be safe in selected cases with
clinically negative axillae. However, the incorporation of this evidence into practice is gradual.
Objective: To evaluate the trend toward axillary surgical de-escalation in a mastology service between 2023 and 2025.
Methods: A retrospective descriptive study was conducted with analysis of medical records from the Mastology Service
of the Dr. Arnaldo Cancer Institute. The database is ongoing, with preliminary data from breast surgical procedures with
axillary management being included. The variables were the type of axillary procedure, type of surgery, and use of neoadjuvant chemotherapy (NAC).
Results: A total of 270 axillary procedures were analyzed. SLNB was performed in 136 cases (50.4%) and ALND in 134
(49.6%). The SLNB rate increased from 37.9% in 2023 to 60.0% in 2024. In breast-conserving surgery, SLNB was predominantly performed, while in mastectomies, ALND was the most prevalent (75 ALND vs 17 SLNB). Without NAC, SLNB was
more frequent (59.2%); post-NAC, ALND predominated (72.6%).
Conclusion: The service demonstrates progressive incorporation of evidence from Z0011, with a significant increase in
SLNB over two years. The persistence of ALND post-NAC and in mastectomies reflects scenarios still under debate, with
potential for future de-escalation.
Ethics: Research Ethics Committee Approval (CAAE 74462723.1.0000.5471).

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Published

2026-10-19

How to Cite

da Silva, S. da C. e S. F., Lazarini, G. S., Tengan, F. M., da Silva, R. M., Borges, V. M., Fristachi, C. E., & Rodrigues, F. F. O. (2026). 1168 – De-escalation of axillary management in breast cancer: analysis of real-life data from a mastology service. Mastology, 36(suppl. 1). https://doi.org/10.29289/259453942025V36S11168

Issue

Vol. 36 No. suppl. 1 (2026)

Section

Locoregional Treatment Section

License

Copyright (c) 2026 Stephani da Costa e Sousa Freire da Silva, Giulia Severini Lazarini, Fernanda Mayumi Tengan, Rodrigo Macedo da Silva, Vinicius Miranda Borges, Carlos Elias Fristachi, Fábio Francisco Oliveira Rodrigues

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.