In the ACOSOG Z0011 trial, which subset of breast cancer patients with sentinel node macrometastases was found to NOT require axillary lymph node dissection?

• A Patients undergoing mastectomy with 1–2 positive sentinel nodes
• B Patients undergoing breast-conserving surgery with 1–2 positive sentinel nodes receiving whole-breast radiation ✓
• C Patients with 3 or more positive sentinel nodes undergoing lumpectomy
• D All cN0 patients regardless of sentinel node status

Explanation

The ACOSOG Z0011 trial established that in clinically node-negative patients undergoing breast-conserving surgery followed by whole-breast irradiation, those with 1–2 sentinel node macrometastases do not require completion axillary lymph node dissection, as overall survival and regional recurrence rates are equivalent. This landmark finding changed practice by avoiding morbid axillary dissection in selected patients. The trial specifically excluded patients having mastectomy, those receiving partial breast irradiation, and those with 3 or more positive nodes.

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

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