The ALMANAC trial established the role of sentinel lymph node biopsy in breast cancer by comparing it to axillary lymph node dissection. Which finding of this trial changed clinical practice most significantly?
- A Sentinel node biopsy identified more positive nodes than axillary dissection
- B Axillary dissection had lower rates of lymphedema than sentinel node biopsy
- C Sentinel node biopsy had equivalent survival outcomes with lower morbidity than axillary dissection ✓
- D Sentinel node biopsy required frozen section analysis in all cases
Correct answer: C. Sentinel node biopsy had equivalent survival outcomes with lower morbidity than axillary dissection
Explanation
The ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance) trial demonstrated that sentinel lymph node biopsy achieved equivalent regional control and survival compared to axillary lymph node dissection, while resulting in significantly lower rates of lymphedema, sensory loss, and arm morbidity. This validated sentinel node biopsy as the standard staging procedure for clinically node-negative early breast cancer. Options B and C are factually incorrect, and frozen section is not universally mandated.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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