In the ACOSOG Z0011 trial, which patient population was eligible, and what was the key finding that changed axillary management in breast surgery?

• A Mastectomy patients with 1–2 positive SLN; ALND had no OS benefit
• B Neoadjuvant chemotherapy patients; ALND could be omitted after ypN0
• C Triple-negative breast cancer; ALND increased locoregional recurrence
• D Lumpectomy patients with 1–2 positive SLN receiving whole-breast RT; ALND had no OS or DFS benefit ✓

Explanation

ACOSOG Z0011 enrolled patients undergoing breast-conserving surgery (lumpectomy) with 1–2 positive sentinel lymph nodes who received whole-breast radiation and systemic therapy. It showed that omitting ALND did not compromise overall survival or disease-free survival, establishing that ALND is not routinely required for this subgroup. This trial fundamentally changed practice: ALND is now omitted when ≤ 2 SLN are positive in lumpectomy patients receiving whole-breast RT. It does not apply to mastectomy patients or those with ≥ 3 positive nodes.

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

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