A 52-year-old woman with newly diagnosed invasive ductal carcinoma of the right breast (2 cm, ER+/PR+/HER2−, clinically node-negative) undergoes sentinel lymph node biopsy. Two sentinel nodes contain isolated tumour cells (ITC, <0.2 mm). According to the ACOSOG Z0011 trial criteria, what is the most appropriate next step?

• A Complete axillary lymph node dissection is mandatory
• B Axillary irradiation alone is sufficient instead of ALND
• C Mastectomy with axillary clearance is required
• D Proceed to breast-conserving surgery with whole-breast irradiation without axillary lymph node dissection ✓

Explanation

The ACOSOG Z0011 trial demonstrated that in women undergoing breast-conserving surgery who have 1–2 positive sentinel nodes and receive adjuvant systemic therapy plus whole-breast irradiation, complete ALND confers no survival benefit. Isolated tumour cells (pN0i+) are considered node-negative by AJCC 8th edition staging and do not alter the management. Options B, C, and D represent unnecessary escalation of locoregional treatment not supported by current evidence.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.