We read with great interest the Article by Giacomo Montagna and colleagues,1 which addresses a pivotal question in contemporary breast cancer care—if axillary lymph node dissection (ALND) can be safely omitted in patients with residual micrometastases (ypN1mi) after neoadjuvant chemotherapy. Their multinational cohort provides much-needed outcome data to inform surgical de-escalation strategies. However, the significantly higher axillary recurrence rate observed in patients with triple-negative breast cancer who did not undergo ALND (8·7% [95% CI 4·4–15·0] vs 2·4% [0·7–6·5]; p=0·018) warrants careful interpretation before this finding influences clinical practice.
The Lancet Oncology published a clinical update in Oncology on 01 Apr 2026.
The item focuses on ALND after neoadjuvant chemotherapy: a call for caution.
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