Breast: Axillary management (Z0011)

Why A is correct

The ACOSOG Z0011 trial showed that in women with cT1-2 tumours, no palpable adenopathy and 1-2 positive sentinel nodes treated with breast conservation, whole-breast radiotherapy and systemic therapy, sentinel node dissection alone gave 10-year overall survival non-inferior to axillary dissection (86.3% vs 83.6%), allowing completion axillary clearance to be safely omitted. This patient meets all the Z0011 criteria.

And why the others are not

• BIncorrect. Z0011 demonstrated that completion axillary dissection can be omitted in this exact group without compromising survival or regional control, while adding morbidity.
• CIncorrect. Repeat sentinel node biopsy has no role here; the axilla has already been staged.
• DIncorrect. Additional node sampling is not indicated and offers no benefit over the Z0011 approach.
• EIncorrect. Mastectomy with clearance is overtreatment; breast conservation with radiotherapy is appropriate and the axilla can be managed without clearance.

Source ACOSOG Z0011 (Alliance) - omission of axillary dissection (10-year results) — Giuliano AE, Ballman KV, McCall L, et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918-926.