A 55-year-old woman undergoes sentinel lymph node biopsy (SLNB) for a 2 cm ER-positive breast carcinoma and has 2 sentinel nodes found positive for metastasis. She is planned for breast-conserving surgery and whole-breast radiotherapy. According to the ACOSOG Z0011 trial criteria, the next step is:
- A No further axillary surgery is required ✓
- B Completion axillary lymph node dissection (ALND)
- C Axillary radiotherapy alone without ALND
- D Modified radical mastectomy with ALND
Correct answer: A. No further axillary surgery is required
Explanation
The ACOSOG Z0011 trial showed that patients with T1–T2 tumors undergoing breast-conserving surgery and whole-breast radiotherapy who have 1–2 positive sentinel lymph nodes do not require completion ALND, as there is no difference in locoregional recurrence or overall survival. This applies only when meeting Z0011 criteria: clinically node-negative, BCS + whole-breast RT planned. ALND adds morbidity without survival benefit in this setting.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.