In the Z0011 trial, sentinel lymph node biopsy (SLNB) showed 1-2 positive sentinel nodes in patients with early breast cancer undergoing breast-conserving surgery (BCS) and whole breast irradiation. Which management was shown to be non-inferior to axillary lymph node dissection (ALND) in this trial?

• A Axillary irradiation alone without further surgery
• B Sentinel node excision followed by regional nodal irradiation mandatorily
• C ALND restricted to clinically palpable nodes only
• D No further axillary surgery (SLNB alone) ✓

Explanation

The ACOSOG Z0011 trial (Giuliano et al., JAMA 2011) showed that in patients with T1-2 N0 breast cancer having BCS plus whole breast irradiation with 1-2 positive SLNs, SLNB alone (without completion ALND) yielded non-inferior overall survival and disease-free survival at 10 years. This landmark trial shifted practice away from routine ALND for limited sentinel node involvement. Patients undergoing mastectomy or those with > 2 positive sentinel nodes were excluded from Z0011 criteria.

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

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Written and medically reviewed by the StethoPrep medical team.