A 45-year-old woman with newly diagnosed invasive ductal carcinoma of the right breast (cT2N1M0) undergoes sentinel lymph node biopsy which shows 2 of 3 sentinel nodes positive for metastasis. The Z0011 trial criteria are reviewed. According to the ACOSOG Z0011 trial, which of the following is the most appropriate next step?
- A Proceed to axillary lymph node dissection (ALND) immediately
- B Perform ALND only if more than 3 sentinel nodes are positive
- C Omit ALND if she is planned for breast-conserving surgery with whole-breast radiotherapy and systemic therapy ✓
- D Perform axillary radiotherapy and then reassess for ALND
Correct answer: C. Omit ALND if she is planned for breast-conserving surgery with whole-breast radiotherapy and systemic therapy
Explanation
The ACOSOG Z0011 trial demonstrated that in clinically node-negative patients with 1-2 sentinel node macrometastases undergoing breast-conserving surgery with whole-breast radiotherapy and systemic therapy, omission of ALND did not compromise locoregional control or survival. The trial enrolled patients with cT1-2 tumors with 1-2 positive sentinel nodes. ALND is no longer mandatory in this well-defined subset, reducing morbidity without oncological compromise.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.