The Z0011 trial (ACOSOG) fundamentally changed axillary management in early breast cancer. Which patient scenario best fits the Z0011 eligibility criteria where axillary lymph node dissection can safely be omitted?
- A T3 breast cancer, 3 positive sentinel nodes, mastectomy planned
- B T1 breast cancer, 1–2 positive sentinel nodes (macrometastases), breast conservation surgery with whole-breast irradiation ✓
- C T2 cancer with neoadjuvant chemotherapy, 2 positive sentinel nodes
- D T1 cancer undergoing mastectomy with 1 positive sentinel node
Correct answer: B. T1 breast cancer, 1–2 positive sentinel nodes (macrometastases), breast conservation surgery with whole-breast irradiation
Explanation
The Z0011 trial demonstrated that in clinically node-negative patients with T1–T2 tumours, 1–2 positive sentinel lymph nodes (macrometastases), undergoing breast-conserving surgery with whole-breast tangential irradiation and systemic therapy, omission of ALND did not compromise locoregional control or overall survival. The key exclusions were mastectomy patients, those receiving neoadjuvant chemotherapy, and patients with ≥3 positive sentinel nodes. This trial dramatically reduced morbidity from unnecessary ALND.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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