Publication:

The INSEMA trial: redefining axillary surgery in early breast cancer

We read with great interest the INSEMA (Intergroup-Sentinel-Mamma) trial published in the New England journal of medicine in 2025, which evaluates the oncologic safety of omitting sentinel lymph node biopsy (SLNB) in clinically node-negative early breast cancer. This landmark study represents a major step toward surgical de-escalation; however, important limitations must be carefully considered before widespread implementation, particularly in resource-limited settings.