{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:47:26Z","timestamp":1782452846463,"version":"3.54.5"},"reference-count":53,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Axillary management in early\u2010stage breast cancer has shifted from routine clearance to selective, biology\u2010driven intervention. Advances in systemic therapy, imaging, and radiotherapy have reduced the need for axillary lymph node dissection (ALND), limiting morbidity without compromising oncologic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review summarizes evidence supporting surgical de\u2010escalation, targeted axillary dissection (TAD), and regional nodal irradiation (RNI), drawing on randomized trials, prospective cohorts, and international guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Randomized trials show that completion ALND can be safely omitted in patients with limited sentinel lymph node (SLN) involvement, with equivalent survival and lower lymphedema rates. Noninferiority studies indicate that SLN biopsy itself may be omitted in selected low\u2010risk patients with negative axillary imaging. In biopsy\u2010proven node\u2010positive disease treated with neoadjuvant therapy, TAD\u2014retrieving the clipped node together with SLNs\u2014reduces false\u2010negative rates to \u2264\u20095%, allowing omission of ALND in responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Axillary treatment has evolved toward individualized, minimally invasive strategies guided by tumor biology, treatment response, and patient priorities, requiring multidisciplinary decision\u2010making to optimize outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70820","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:11:11Z","timestamp":1782450671000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of the Axilla for Early\u2010Stage Breast Cancer: A State\u2010Of\u2010The\u2010Art Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9639-4486","authenticated-orcid":false,"given":"Fausto","family":"Petrelli","sequence":"first","affiliation":[{"name":"Oncology Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Pavesi","sequence":"additional","affiliation":[{"name":"Radiology Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agostina","family":"De Stefani","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Felici","sequence":"additional","affiliation":[{"name":"Breast Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ruggiero","sequence":"additional","affiliation":[{"name":"Breast Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Seghezzi","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Esposito","sequence":"additional","affiliation":[{"name":"Radiology Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvia Milena","family":"Cribiu'","sequence":"additional","affiliation":[{"name":"Pathology Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Mercurio","sequence":"additional","affiliation":[{"name":"Pathology Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Burgoa","sequence":"additional","affiliation":[{"name":"Breast Unit, ASST Bergamo Ovest  Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.22336\/jml.2016.018"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063\u2010022\u201006331\u2010w"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022152"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.25.00099"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11470"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010025\u201014105\u2010z"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010025\u201016973\u2010y"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003400"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010014\u20103417\u20100"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957\u2010023\u201003048\u20108"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957\u2010015\u20100736\u2010x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010024\u201016143\u20106"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008108"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21393"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.25.00099"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2313487"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.3759"},{"key":"e_1_2_6_19_1","unstructured":"M. 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