Toward the Abandonment of Axillary Surgery: Is This the End of an Era?

Axillary surgery in breast cancer has evolved substantially from radical surgical approaches toward minimally invasive and, in selected cases, non-surgical strategies. This editorial summarizes emerging techniques for axillary staging, with particular emphasis on advanced imaging and optical spectroscopic methods, including contrast-enhanced ultrasonography, Raman spectroscopy, optical coherence tomography, Fourier-transform infrared spectroscopy, elastic scattering spectroscopy, and refractometry. These modalities demonstrate promising diagnostic accuracy and may allow for preoperative or intraoperative axillary staging, obviating the need for surgical excision. At the same time, ongoing randomized trials are investigating the omission of sentinel lymph node biopsy in carefully selected patients with early-stage breast cancer and clinically negative axillary lymph nodes. Early results suggest oncological safety in low-risk populations, although longer follow-up data are required. These developments suggest a future of personalized axillary management, potentially marking the beginning of the end for routine axillary surgery in breast cancer care.