In the NSABP B-04 trial, long-term follow-up demonstrated which key finding regarding axillary lymph node dissection in clinically node-negative breast cancer?

• A Immediate ALND improved overall survival compared to delayed ALND
• B Radical mastectomy had superior survival to total mastectomy with radiation
• C Sentinel node biopsy was non-inferior to ALND in the node-negative group
• D No significant difference in overall survival between radical, total with radiation, and total mastectomy alone ✓

Explanation

The landmark NSABP B-04 trial with 25-year follow-up found no significant difference in overall survival among three treatment arms: radical mastectomy (Halsted), total mastectomy plus regional irradiation, and total mastectomy alone (with delayed ALND for recurrence). This trial established that local-regional control does not translate into survival benefit, supporting the concept that micrometastatic disease is systemic at presentation. Sentinel node biopsy was not part of this 1970s trial.

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.