# New Insight for Axillary De-Escalation in Breast Cancer Surgery: “SoFT Study” Retrospective Analysis

## TL;DR

This study explores factors that could help decide if certain breast cancer patients can skip a specific surgery step, potentially saving time and resources.

## Contribution

The study identifies preoperative factors associated with lymph node involvement in early breast cancer patients, supporting axillary de-escalation strategies.

## Key findings

- Multifocality, higher cT stage, and larger tumor diameter were more common in patients with lymph node involvement.
- Tumor biology, including hormone receptors and molecular subtypes, was associated with lymph node involvement.
- A significant portion of patients were eligible for axillary de-escalation, potentially saving substantial operating room time.

## Abstract

Background: The SOUND study demonstrated that an axillary de-escalation may be sufficient in locoregional and distant disease control in selected early breast cancer (EBC) patients. To establish any preoperative variables that may drive sentinel lymph node biopsy (SLNB) omission, a study named sentinel omission risk factor (SOFT) 1.23 was planned. Methods: A single-center retrospective study from a prospectively maintained database was designed, aiming at underlying preoperative prognostic factors involved in sentinel lymph node (SLN) metastasis (lymph node involvement (LN+) vs. negative lymph node (LN−) group). Secondary outcomes included surgical room occupancy analysis for SLNB in patients fulfilling the SOUND study inclusion criteria. The institutional ethical committee Area Territoriale Lazio 2 approved the study (n° 122/23). Results: Between 1 January 2022 and 30 June 2023, 160 patients were included in the study and 26 (%) were included in the LN+ group. Multifocality, higher cT stage, and larger tumor diameter were reported in the LN+ group (p = 0.020, p = 0.014, and 0.016, respectively). Tumor biology, including estrogen and progesterone receptors, and molecular subtypes showed association with the LN+ group (p < 0.001; p = 0.001; and p = 0.001, respectively). A total of 117 (73.6%) patients were eligible for the SOUND study and the potential operating room time saved was 2696.81 min. Conclusions: De-escalating strategies may rationalize healthcare activities. Multifactorial risk stratification may further refine the selection of patients who could benefit from SLNB omission.