A 52-year-old postmenopausal woman undergoes wide local excision for a 1.8 cm grade 2 invasive ductal carcinoma. Sentinel lymph node biopsy shows two out of three sentinel nodes positive with micrometastases (deposits 0.2–2 mm). According to ACOSOG Z0011 trial criteria, the most appropriate management is:
- A Completion axillary lymph node dissection
- B Axillary radiotherapy alone
- C Whole breast radiotherapy without axillary dissection ✓
- D Axillary dissection followed by chemotherapy
Correct answer: C. Whole breast radiotherapy without axillary dissection
Explanation
The ACOSOG Z0011 trial showed that in patients undergoing breast-conserving surgery with T1-T2 tumors, 1-2 positive sentinel lymph nodes, and planned whole-breast irradiation, omission of axillary lymph node dissection did not compromise locoregional control or survival. Whole breast radiotherapy adequately treats low-burden axillary disease without the morbidity of dissection. Axillary dissection is reserved for three or more positive sentinel nodes or cases not meeting Z0011 criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.