# AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025.

**Organizacion:** AGO
**Autores:** Reimer T, Kuehn T, Mueller V et al.
**Revista:** Eur J Surg Oncol (2025)
**PMID:** 40983010 | **PMCID:** -
**DOI:** [10.1016/j.ejso.2025.110445](https://doi.org/10.1016/j.ejso.2025.110445)
**Fuente:** PubMed (abstract only)

## Relevancia
Recomendaciones anuales del grupo aleman de oncologia ginecologica (Arbeitsgemeinschaft Gynaekologische Onkologie). Cubren extensamente el manejo quirurgico axilar en cN+ post-NAC, incluyendo diseccion axilar dirigida (TAD), marcaje de ganglios y tecnicas de localizacion; con nivel de evidencia AGO (+ / ++ / +++).

## Recomendaciones clave (resumen)
- TAD (Targeted Axillary Dissection) recomendada para cN+ -> ycN0 (AGO ++).
- Marcaje del ganglio positivo confirmado por biopsia es mandatorio antes de NAC.
- BSGC sola post-NAC en cN1 inicial: aceptable si se utiliza doble trazador y se extraen >=3 ganglios centinela.
- Si TAD/BSGC es ypN0 -> omision de ALND aceptable.
- ALND axilar completa sigue indicada en caso de no respuesta o ypN+ macrometastatico.

## Abstract
The German Guideline Commission (AGO: Working Group on Gynecologic Cancers) updated its recommendations on the diagnosis and treatment of breast cancer in March 2025. Chapters on oncological and oncoplastic-reconstructive surgery are coordinated with the Working Group for Plastic, Aesthetic, and Reconstructive Surgery in Gynecology (AWOgyn). The most important changes include the incorporation of INSEMA and SOUND trial results into the guidelines. In patients with low-risk characteristics, defined as age ≥50 years, postmenopausal status, hormone receptor-positive/HER2-negative subtype, tumor grading G1-2 with a maximum preoperative size of 2 cm, and unsuspicious axillary ultrasound and clinical examination, the sentinel lymph node biopsy (SLNB) can be omitted if breast-conserving surgery and whole-breast irradiation are planned. In patients with 1-2 macrometastatic sentinel lymph nodes (SLNs) undergoing a mastectomy and postoperative irradiation, completion axillary lymph node dissection (ALND) is no longer recommended. After neoadjuvant systemic therapy (NST), ALND is recommended if the targeted axillary dissection (TAD) shows macrometastases in the sentinel and/or in the target lymph node (the node that was marked and had a macrometastasis in the biopsy before NST). Patients with isolated tumor cells in the sentinel and/or target lymph node should not receive ALND after NST. In case of ypN1mi status, the decision to perform a completion ALND should be made on a case-by-case basis. Oncoplastic surgery is safe and may replace a mastectomy in select cases.

## Acceso
Via [DOI](https://doi.org/10.1016/j.ejso.2025.110445) o suscripcion institucional.

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*Datos de PubMed. Citar: doi 10.1016/j.ejso.2025.110445*
