Background/Objectives: De-escalation of axillary surgery with sentinel lymph node biopsy (SLNB) has been shown to decrease morbidity in breast cancer patients without affecting oncological outcomes. However, there are very few reports on its applicability in real-world clinical practice, especially in middle-income countries.Methods: A retrospective historical cohort study was conducted, including 787 patients with clinical stage I–IIIA breast cancer treated from 2013 to 2023 at the INC in Colombia. Two groups were analyzed based on the timing of the axillary procedure: patients undergoing SLNB as initial surgery (Upfront SLNB) and those receiving neoadjuvant chemotherapy (Post-NACT SLNB).Results: The overall sentinel lymph node (SLN) identification rate was 99.3%. SLN positivity was 32% in Upfront SLNB and 13.1% in Post-NACT SLNB. Axillary lymph node dissection (ALND) was omitted in 56% of patients with node-positive Upfront SLNB; it was avoided in 86.8% of the Post-NACT group with complete axillary response (ypN0). Regional recurrence rates were 2.33%. In multivariate analysis, the main factors linked to recurrence and mortality were triple-negative and luminal B HER2-negative biological subtypes, histological grade 2, and tumor size ≥ 2 cm. At 60 months of follow-up, 91.4% (95% CI: 88.9–93.9) of patients remained recurrence-free (time-recurrence (TR)), and overall survival (OS) was 96.1% (95% CI: 94.5–97.7), with no differences observed based on the axillary surgical strategy.Conclusions: Sentinel lymph node biopsy (SLNB) is an oncologically safe procedure for patients with early-stage and locally advanced breast cancer with an adequate response to neoadjuvant systemic treatment.
背景/目的：通过前哨淋巴结活检（SLNB）实现腋窝手术降级已被证实可降低乳腺癌患者的并发症发生率，且不影响肿瘤学预后。然而，关于其在真实世界临床实践中适用性的报道极少，尤其是在中等收入国家。 方法：本研究为回顾性历史队列研究，纳入2013年至2023年在哥伦比亚国家癌症研究所治疗的787例临床分期为I–IIIA期的乳腺癌患者。根据腋窝手术时机将患者分为两组：初始即接受SLNB手术（前期SLNB组）和接受新辅助化疗后行SLNB（新辅助治疗后SLNB组）。 结果：总体前哨淋巴结识别率为99.3%。前期SLNB组的前哨淋巴结阳性率为32%，新辅助治疗后SLNB组为13.1%。在淋巴结阳性的前期SLNB患者中，56%避免了腋窝淋巴结清扫；在新辅助治疗后达到腋窝完全缓解（ypN0）的患者中，86.8%避免了该手术。区域复发率为2.33%。多变量分析显示，与复发和死亡率相关的主要因素为三阴性及Luminal B型HER2阴性生物学亚型、组织学2级和肿瘤大小≥2厘米。随访60个月时，91.4%（95% CI：88.9–93.9）的患者保持无复发生存（时间-复发终点），总生存率为96.1%（95% CI：94.5–97.7），且不同腋窝手术策略组间未见显著差异。 结论：对于早期及局部晚期乳腺癌患者，若对新辅助系统治疗反应良好，前哨淋巴结活检是一种肿瘤学安全性有保障的手术方式。
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