摘要The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly dimin-ished the extent of surgery required for regional lymph nodes.Recent studies have been aimed at avoiding axillary surgery by performing preoperative imaging diagnosis in patients with low tumor burden1,2.Nonetheless,for most patients with breast cancer,the excision of some(sentinel)or even all regional lymph nodes remains imperative.In the past,the goals of surgical de-escalation in the treatment of regional lymph nodes in breast cancer were improving quality of life and decreasing complications,without compromising patient outcomes or survival3.However,this approach overlooked the critical functions of regional lymph nodes in the anti-tumor immune response.Given the increased importance of immu-notherapy in breast cancer treatment,the immune response implications should be considered in decision-making regard-ing the method and extent of surgery.Particularly for patients anticipated to undergo immunotherapy,might a rationale exist for surgical preservation of regional lymph nodes(com-pletely avoiding axillary surgery)to the greatest extent feasible,in light of anti-tumor immunity?