初级全身治疗（PST）的使用和有效性提高了定制局部区域治疗的能力。大约三分之一的临床淋巴结阳性（cN+）乳腺癌患者可以达到腋窝病理完全缓解（pCR），HER2阳性或三阴性乳腺癌亚型观察到更高的比率。对于有腋窝病理完全缓解的患者，定制腋窝治疗是必要的，因为他们不太可能从腋窝淋巴结清扫（ALND）中获益，但可能会遭受淋巴水肿和肩关节活动受限等并发症和长期发病率。通过结合术前和术后腋窝分期技术，可以在大多数cN+ pCR患者中省略ALND。不同的术后腋窝分期技术（MARI/TAD/SN）显示出较低的假阴性率或超低的假阴性率，用于探测残留疾病。更重要的是，使用MARI程序（在腋窝淋巴结上标记放射性碘种子）或同扫描淋巴结活检（SLNB）作为术后腋窝分期技术的试验已经显示了定制优良反应患者的腋窝治疗安全性。使用MARI程序的I-III期乳腺癌的定制腋窝治疗导致ALND减少80%，五年腋窝复发自由期（aRFI）良好率为97%。在I-II期患者中，术后SLNB显示出类似的肿瘤学结果。MARI技术仅需要一次术前有创操作，术后预计只需切除中位1个淋巴结；而SLNB和TAD技术需要切除2至4个淋巴结。MARI技术的一个缺点是其使用放射性碘，受到广泛的监管规定。版权所有 © 2023 作者。由Elsevier Ltd.出版。保留所有权利。

The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth factor Receptor (HER)2-positive or triple negative (TN) breast cancer subtypes. Tailoring axillary treatment for patients with axillary pCR is necessary, as they are unlikely to benefit from axillary lymph node dissection (ALND), but may suffer complications and long-term morbidity such as lymphedema and impaired shoulder motion. By combining pre-PST and post-PST axillary staging techniques, ALND can be omitted in most cN + patients with pCR. Different post-PST staging techniques (MARI/TAD/SN) show low or ultra-low false negative rates for detection of residual disease. More importantly, trials using the MARI (Marking Axillary lymph nodes with Radioactive Iodine seeds) procedure or sentinel lymph node biopsy (SLNB) as axillary staging technique post-PST have already shown the safety of tailoring axillary treatment in patients with an excellent response. Tailored axillary treatment using the MARI procedure in stage I-III breast cancer resulted in 80% reduction of ALND and excellent five-year axillary recurrence free interval (aRFI) of 97%. Similar oncologic outcomes were seen for post-SLNB in stage I-II patients. The MARI technique requires only one invasive procedure pre-NST and a median of one node is removed post-PST, whereas for the SLNB and TAD techniques two to four nodes are removed. A disadvantage of the MARI technique is its use of radioactive iodine, which is subject to extensive regulations.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.