Abstract
The surgical procedure of complete axillary lymph node dissection, which initially included all the level I, II, and III nodes combined with a radical mastectomy in breast cancer patients, de-escalated to include only level I and II nodes with a modified radical mastectomy, leaving intact level III nodes. The sentinel node era, which began thirty years ago, allowed for removal of a small number of only level I nodes. The further decrease in the extent of node removal did not decrease the likelihood of curing patients with breast cancer. In addition, diminished axillary nodal surgery resulted in less complications, including less arm lymphedema. The latest advance is to use clinical, radiological, pathological, molecular, genetic, and other criteria to select breast cancer patients in whom all axillary nodal surgery can be avoided. In this review we summarize the current recommendations for axillary lymph node surgery, highlight and discuss the concomitant development of lymph node imaging, molecular genetic technologies, improved systemic and locoregional therapies, and more clearly elucidate the potential indications for omission of axillary nodal surgery.