The recently published ACOSOG Z0011 trial concluded that ALND offers no survival advantage over SLN dissection alone in women with T1-T2 invasive breast cancer with no palpable adenopathy and one or two lymph nodes that contain metastases identified by frozen section, touch preparation, or H&E staining.
Sentinel node micrometastases (defined as H&E tumor deposits no greater than 2 mm in size) were identified in 37.5% of patients in the ALND group vs. 45% of those in the SLND group (JAMA 2011;305:569-75).
The Swiss Group for Clinical Cancer Research and the Cancer League of Basel-Stadt and Basel-Land funded the study. Dr. Langer and his coauthors disclosed no conflicts.