How would you approach a patient that did not have preoperative axillary imaging and was found to have macromets on sentinel node biopsy, and on radiation planning scan has abnormal appearing nodes?

Prominent node on planning CT is common after SNLN.

However, in this situation based on the pathology, would favor sonogram and biopsy, and if positive, dissection followed by RT.

The probability that the node is additional macromets is high based on the pathology.