A 48-year-old woman undergoing sentinel lymph node biopsy for early breast cancer has a positive sentinel node on intraoperative frozen section showing isolated tumour cells (ITC) measuring 0.1 mm. According to current NCCN guidelines, the most appropriate next step regarding axillary management is:
- A Proceed to immediate axillary lymph node dissection (ALND)
- B No further axillary surgery is required; ITCs are staged as pN0(i+) ✓
- C Repeat sentinel node biopsy from a different quadrant
- D Administer axillary radiotherapy and defer ALND
Correct answer: B. No further axillary surgery is required; ITCs are staged as pN0(i+)
Explanation
Isolated tumour cells (≤0.2 mm or ≤200 cells) in a sentinel node are classified as pN0(i+) and do not mandate axillary lymph node dissection. Current guidelines (NCCN, ASCO-endorsed Z0011 data) reserve ALND for macrometastases (>2 mm). Option A is incorrect because ALND is not indicated for ITCs. Option C is unnecessary as ITCs merely represent pN0(i+) disease. Option D conflates radiotherapy indications, which apply to different clinical settings.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.