Meeting Highlights: The 11th Korean Breast Cancer Society Consensus Conference on Axillary Management in Early Breast Cancer.

The 11th Korean Breast Cancer Society (KBCS) Consensus Meeting was convened to discuss the current expert opinions and practice patterns regarding controversial issues in the axillary management of early breast cancer in Korea. Fifty-three multidisciplinary experts participated in the panel voting. The case-based questions addressed three major domains: 1) omission of sentinel lymph node biopsy (SLNB) in clinically node-negative disease, 2) management of sentinel lymph node (SLN) micrometastases after upfront surgery, and 3) axillary management after neoadjuvant chemotherapy (NAC) for biopsy-proven node-positive disease. The panelists showed a cautious attitude toward SLNB omission in relatively younger postmenopausal patients, even when the clinicopathologic features were consistent with contemporary de-escalation trials, whereas support for omission increased substantially in older low-risk patients. For SLN micrometastases after upfront surgery, completion of axillary lymph node dissection (ALND) is rarely supported, although opinions vary regarding the need for axillary radiotherapy. In the neoadjuvant setting, routine clip placement in biopsy-proven positive nodes has not yet been universally adopted. However, there is strong support for omitting ALND in patients who convert to a clinically node-negative status with negative SLNs after NAC. The management of residual nodal disease after NAC remains controversial, particularly in cases of residual macrometastasis. The 11th KBCS Consensus Meeting demonstrated broad acceptance of axillary surgical de-escalation in selected clinical scenarios, while highlighting a persistently uncertain area. These findings emphasize the need for individualized, multidisciplinary decision-making and further prospective evidence to refine the axillary management of early breast cancer.