Revolutionizing Early-Stage Cancer Surgery: Omitting SLNB in Select Cases

The BOOG 2013-08 trial found that omitting sentinel lymph node biopsy (SLNB) preserved regional control in selected clinically node‑negative, HR‑positive, HER2‑negative early breast cancer, supporting less invasive axillary management.

BOOG 2013-08 was a randomized Phase III trial enrolling 1,733 patients treated with breast‑conserving surgery and whole‑breast radiation; 1,574 were evaluable at a median five‑year follow‑up. The primary endpoint was regional recurrence–free survival; secondary endpoints included regional recurrence rate and overall survival. Randomization to standard SLNB versus omission showed no statistically significant difference in the primary endpoint, and the prespecified non‑inferiority margin was not crossed.

Regional metrics quantify safety: the 5‑year regional recurrence‑free survival was 96.6% with SLNB and 94.2% without; observed regional nodal recurrences were 0.5% versus 1.2%, respectively.

Eligible patients — clinically node‑negative, predominantly HR‑positive/HER2‑negative tumors ≤2 cm treated with breast conservation and whole‑breast irradiation — can be considered for SLNB omission. Omission reduces operative time, sentinel‑mapping resource use, and pathology workload while retaining standard radiation workflows, creating a streamlined axillary pathway for appropriate candidates.

Omitting SLNB reduces expected surgical morbidity and lymphedema risk and may speed early recovery with potential quality‑of‑life gains; endocrine and radiation decisions are unchanged in most cases. The net result is a measurable reduction in invasiveness without compromising oncologic outcomes.

Key Takeaways:

• What’s new? The BOOG 2013-08 randomized Phase III data demonstrate non‑inferior regional control when SLNB is omitted in selected early‑stage HR+/HER2− patients.
• Who’s affected? Clinically node‑negative patients with small, HR‑positive, HER2‑negative tumors managed with breast conservation and whole‑breast radiation are the primary group impacted.
• What changes next? Axillary surgical pathways can be de‑escalated for eligible patients, with adjustments to operative planning and pathology workflows while maintaining follow‑up surveillance.