The ACOSOG Z0011 trial changed surgical practice for sentinel node biopsy in breast cancer. Which of the following best summarizes its landmark conclusion?

• A Axillary lymph node dissection is mandatory when any sentinel node is positive
• B Sentinel node biopsy is contraindicated after neoadjuvant chemotherapy
• C Completion axillary dissection improves overall survival when sentinel nodes show micrometastases
• D In T1-T2 tumors with 1-2 positive sentinel nodes treated with breast-conserving surgery and whole-breast radiation, axillary dissection can be omitted ✓

Explanation

ACOSOG Z0011 (Giuliano et al., JAMA 2011) demonstrated that for patients with T1-T2 clinically node-negative breast cancer with 1–2 positive sentinel lymph nodes who underwent breast-conserving surgery plus whole-breast radiation, axillary lymph node dissection provided no survival benefit over sentinel node biopsy alone. This trial significantly reduced the use of completion axillary dissection in suitable patients.

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

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