Data from the SOUND study and results presented at the 2024 San Antonio Breast Cancer Symposium (SABCS) from the INSEMA trial suggest that, for certain breast cancer patients meeting specific criteria-including older age, smaller tumor size, preoperative tumor size <2 cm, and histological grade 1-2 HR+/HER2- tumors-waiving ALND does not significantly affect survival, prognosis, or the risk of local recurrence (49, 50). This evidence concerns the gene ERBB2 and breast cancer.