A 45-year-old woman undergoes sentinel lymph node biopsy (SLNB) for clinically node-negative breast cancer. Two sentinel nodes are found positive with micrometastases (each <2mm). She will receive whole-breast radiation and systemic therapy. According to the ACOSOG Z0011 trial criteria, what is the appropriate next step?

• A Proceed to axillary lymph node dissection (ALND)
• B Repeat SLNB with different tracer
• C Axillary radiotherapy alone without ALND
• D No further axillary surgery is required ✓

Explanation

The ACOSOG Z0011 trial demonstrated that for patients with T1-T2 breast cancer undergoing breast-conserving surgery with 1-2 positive sentinel nodes who receive whole-breast radiation and systemic therapy, ALND can be safely omitted without compromising locoregional control or survival. This landmark trial changed the standard of care and significantly reduced the morbidity of axillary surgery. ALND is still indicated for 3 or more positive sentinel nodes, patients undergoing mastectomy, or those not receiving radiation.

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

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Written and medically reviewed by the StethoPrep medical team.