Multinational phase 3 trial of SLNB vs no axillary surgery for small breast cancer with negative ultrasonography results of axillary lymph nodes

Sentinel lymph node biopsy (SLNB) is the standard of care for axillary node staging of patients with early breast cancer (BC), but its necessity can be questioned since surgery for examination of axillary nodes is not performed with curative intent. The multinational randomized phase 3 SOUND trial investigated whether omission of axillary surgery is noninferior to SLNB in patients with small (≤ 2 cm) BC and a negative result on preoperative axillary lymph node ultrasonography. The group of patients who did not undergo axillary surgery had noninferior 5-yeas distant disease-free survival compared with the group patients who underwent SLNB. The authors conclude that patients with these characteristics can be safely spared axillary surgery whenever the lack of pathological information does not affect the postoperative treatment plan.