A 45-year-old woman undergoes sentinel lymph node biopsy (SLNB) for T1N0 invasive ductal carcinoma. Two sentinel nodes are removed: one contains a 0.4 mm cluster of tumor cells and the other is negative. According to ACOSOG Z0011 trial criteria, what is the recommended management?
- A Proceed to completion axillary lymph node dissection
- B Axillary radiotherapy as alternative to SLNB
- C No axillary dissection if she will undergo whole breast irradiation and systemic therapy ✓
- D Repeat SLNB with greater radiotracer dose
Correct answer: C. No axillary dissection if she will undergo whole breast irradiation and systemic therapy
Explanation
A 0.4 mm deposit is classified as isolated tumour cells (ITC; ≤0.2 mm or <200 cells qualifies as pN0(i+)). However, even for patients with 1–2 positive sentinel nodes undergoing breast-conserving surgery with whole breast radiation and systemic therapy, the ACOSOG Z0011 trial showed no survival benefit from completion axillary lymph node dissection. ITCs are effectively node-negative for staging; omitting axillary dissection is appropriate under these criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.