A 45-year-old woman with invasive lobular carcinoma of the right breast, T2N0M0, ER+/PR+/HER2-, undergoes sentinel lymph node biopsy which reveals 2 positive sentinel nodes with no extranodal extension. Per the Z0011 trial criteria, what is the recommended axillary management if she proceeds to breast-conserving surgery with whole breast irradiation?
- A Completion axillary lymph node dissection is mandatory
- B Axillary lymph node dissection can be omitted ✓
- C Axillary radiotherapy alone is the next step
- D Neoadjuvant chemotherapy followed by re-staging is required
Correct answer: B. Axillary lymph node dissection can be omitted
Explanation
The ACOSOG Z0011 trial showed that in clinically T1-T2 N0 patients undergoing breast-conserving surgery with whole breast irradiation who have 1-2 positive sentinel nodes, completion axillary dissection does not improve survival or locoregional control. Axillary dissection can safely be omitted. Option A would subject the patient to unnecessary morbidity including lymphoedema. Option C is not a standard first-line approach when Z0011 criteria are met. Option D is not indicated for this stage.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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