In the ACOSOG Z0011 trial, patients with clinically node-negative breast cancer and 1–2 positive sentinel lymph nodes who underwent breast-conserving surgery and whole-breast irradiation were NOT subjected to completion axillary lymph node dissection. The key conclusion was:
- A Overall survival was significantly improved by avoiding ALND
- B ALND omission is safe only if the sentinel node shows only isolated tumor cells
- C ALND omission did not compromise locoregional control or survival when adjuvant systemic therapy was given ✓
- D Axillary recurrence was significantly higher in the observation arm
Correct answer: C. ALND omission did not compromise locoregional control or survival when adjuvant systemic therapy was given
Explanation
ACOSOG Z0011 established that in clinically T1-T2 N0 patients with 1–2 positive sentinel nodes treated with breast-conserving surgery plus whole-breast radiation and systemic adjuvant therapy, omission of ALND resulted in non-inferior locoregional recurrence and survival at 10 years. This does not apply to patients with ≥3 positive nodes, mastectomy, or no radiation. Axillary recurrence rates were similar (~1%) in both arms.
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.