The ACOSOG Z0011 trial changed sentinel lymph node biopsy (SLNB) practice. Which of the following most accurately represents its key conclusion?

• A Completion axillary lymph node dissection (ALND) is mandatory when 1-2 sentinel nodes contain macrometastases in patients undergoing mastectomy
• B Completion ALND is required when sentinel node shows isolated tumour cells regardless of planned surgery type
• C SLNB should be abandoned in favour of ALND for all T2 tumours
• D Completion ALND can be safely omitted in clinically node-negative patients with 1-2 positive sentinel nodes who undergo breast-conserving surgery with whole-breast radiotherapy ✓

Explanation

The ACOSOG Z0011 trial demonstrated that in clinically node-negative patients undergoing breast-conserving surgery and whole-breast radiotherapy, omitting completion ALND in those with 1-2 positive sentinel nodes did not compromise 10-year overall or disease-free survival. This transformed practice by avoiding the morbidity of ALND in a significant subset of patients. The findings do not apply to mastectomy patients (covered by AMAROS/OTOASOR trials) or to those with 3 or more positive sentinel nodes.

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

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