Which of the following correctly describes the Z0011 trial criteria under which axillary lymph node dissection (ALND) can be omitted despite 1–2 positive sentinel nodes?

• A T1–T2 tumour, planned mastectomy, whole breast radiotherapy, 1–2 positive SNs
• B T1–T2 tumour, breast-conserving surgery, planned whole-breast tangential radiotherapy, ≤2 positive SNs with no extranodal extension ✓
• C Any tumour size, breast-conserving surgery, regional nodal irradiation, any number of positive SNs
• D T1–T3 tumour, mastectomy with or without radiotherapy, ≤2 positive SNs

Explanation

ACOSOG Z0011 showed that in patients with T1–T2 clinically node-negative breast cancer undergoing breast-conserving surgery with planned tangential whole-breast irradiation, ALND can be safely omitted if ≤2 sentinel nodes are positive without gross extranodal extension. Crucially, the trial excluded mastectomy patients and those receiving non-tangential irradiation, so option B best captures the eligibility criteria.

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

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