Sentinel lymph node biopsy (SLNB) in a patient with clinically node-negative breast cancer reveals 2 positive sentinel nodes with macrometastases. She is planned for breast-conserving surgery and whole-breast radiation. According to the Z0011 trial criteria, what is the appropriate axillary management?

• A Completion axillary lymph node dissection (ALND) is mandatory
• B Regional nodal irradiation must replace SLNB
• C ALND should be deferred pending Oncotype DX results
• D ALND can be safely omitted if she meets Z0011 eligibility criteria ✓

Explanation

The ACOSOG Z0011 trial showed no survival difference between SLNB alone versus ALND in patients with T1–T2, clinically node-negative breast cancer, 1–2 positive sentinel nodes, breast-conserving surgery, and whole-breast radiation. ALND is therefore safely omitted in these patients. ALND remains indicated for ≥3 positive sentinel nodes, mastectomy cases (unless AMAROS/POSNOC criteria met), or if tangential fields do not cover the axilla. Oncotype DX does not dictate axillary surgery.

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

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Written and medically reviewed by the StethoPrep medical team.