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General Surgery · Breast and endocrine surgery: sentinel node biopsy and axillary management
Sample itemA woman with a 2 cm clinically node-negative breast cancer undergoes breast-conserving surgery with sentinel lymph node biopsy that shows 1 micrometastatic node and she will have whole-breast radiotherapy. According to Z0011-type evidence, what is the axillary management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Completion axillary dissection can be omitted
Sentinel biopsy uses blue dye and radiocolloid for clinically node-negative patients. In T1-T2 tumours treated with breast-conserving surgery and radiotherapy, with 1 to 2 positive sentinel nodes, completion dissection does not improve survival, so it is omitted.
Option by option
A. Mandatory level III axillary clearance
Clearance adds morbidity without survival benefit here.
B. Repeat sentinel biopsy
Repeating the biopsy has no basis.
C. Completion axillary dissection can be omitted (correct)
Correct. Axillary dissection can be omitted in these circumstances.
D. Mastectomy
Mastectomy is not required.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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