The ACOSOG Z0011 trial changed the management of sentinel lymph node biopsy (SLNB) in breast cancer. Which of the following best describes its key conclusion?
- A All patients with positive SLNB require axillary lymph node dissection (ALND)
- B ALND improves overall survival compared to SLNB alone in all node-positive patients
- C Patients with 1-2 positive sentinel nodes undergoing BCS + whole-breast radiation may safely omit ALND ✓
- D Positive sentinel nodes in mastectomy patients do not require further axillary treatment
Correct answer: C. Patients with 1-2 positive sentinel nodes undergoing BCS + whole-breast radiation may safely omit ALND
Explanation
The ACOSOG Z0011 trial showed that in patients with T1-T2 breast cancer undergoing breast-conserving surgery (BCS) with whole-breast irradiation who have 1-2 positive sentinel nodes, omitting ALND did not result in inferior survival or regional control. This landmark trial significantly reduced unnecessary axillary dissections. The trial did not apply to mastectomy patients or those with ≥3 positive nodes.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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