A 52-year-old woman with ER+/PR+/HER2- invasive ductal carcinoma (T2N1M0, grade 2) undergoes sentinel lymph node biopsy revealing 2 positive nodes with no extranodal extension. The Z0011 trial criteria are met. Which is the most appropriate axillary management?
- A Proceed to complete axillary lymph node dissection (ALND)
- B Axillary radiotherapy alone without ALND
- C Omit ALND; treat with breast-conserving surgery and whole-breast radiotherapy ✓
- D Modified radical mastectomy with full ALND
Correct answer: C. Omit ALND; treat with breast-conserving surgery and whole-breast radiotherapy
Explanation
The ACOSOG Z0011 trial demonstrated that in patients with 1-2 positive sentinel nodes undergoing breast-conserving surgery with whole-breast radiotherapy and systemic therapy, omitting ALND did not compromise locoregional control or survival. ALND is therefore avoided to reduce morbidity (lymphedema, nerve injury) in this setting. Complete ALND remains indicated for 3 or more positive sentinel nodes, or if mastectomy is planned without radiotherapy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.