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Editor’s note: Following validation of its accuracy, sentinel lymph node biopsy (SLNB) has evolved to become the standard axillary staging procedure in women with breast cancer. The majority of follow-up studies after negative SLNB have reported few axillary recurrences. However, most of these studies had a relatively short follow-up duration, included relatively small numbers of patients, and were conducted in specialized centers. The current article presents data from a large, multicenter cohort study of SLNB-negative patients with breast cancer.