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In the era of sentinel lymph node biopsy (SLNB), the axillary management concept that 1-2 positive sentinel lymph node (SLN) could safely omit axillary lymph node dissection (ALND) are gradually being accepted by more and more patients. The omission of ALND is safe with no difference in regional recurrence in early breast cancer patients with limited SLN involvement. With the effective support and supplement of systemic therapy and radiotherapy, the management concept of axilla surgery is developing in a de-escalating trend. The combined application of multi-gene tests and ACSOG Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In clinical practice, it is necessary to combine the residual tumor burden of regional lymph nodes to formulate the optimal irradiation fields in patients with 1-2 positive SLNs without ALND. In the era of SLNB, we can make full use of the benefits of systemic therapy and radiotherapy to reasonably reduce the scope of surgery and complications, therefore expand the "net benefit" of efficacy and quality of life. This paper reviewed the optimization of the de-escalation strategy concept for systemic and regional management in patients with 1-2 positive SLNs. [ABSTRACT FROM AUTHOR] more...

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Regional lymph node status is one of the important prognostic indicators of breast cancer, which can guide the staging and adjuvant treatment strategy. Sentinel lymph node biopsy (SLNB) for breast cancer has developed rapidly over the past three decades, evidence-based medicine class Ⅰ evidence supports that SLNB is a safe and effective axillary staging technique for patients with clinically negative axillary lymph node in early breast cancer. The risk of axillary recurrence and complications in breast cancer patients with negative/few-positive sentinel lymph node omitting axillary lymph node dissection is very low. Locoregional management of breast cancer should consider the metastatic risk of the primary tumor, the efficacy and side effects of systemic therapy, and the efficacy and side effects of locoregional therapy (surgery/radiotherapy). This view has promoted the continuous expansion of the SLNB population. SLNB with neoadjuvant therapy and internal mammary SLNB will further promote the de)escalation therapy, and the ongoing studies of omission of axillary surgery should be anticipated. The era of precision medicine for regional lymph node management of breast cancer has gradually arrived with the development of SLNB. This article evaluated the latest progress of precise regional processing of breast cancer in the sentinel lymph node era, in order to provide reference for clinical doctors. [ABSTRACT FROM AUTHOR] more...