Would you pursue ALND in a patient with breast cancer who had a negative sentinel node biopsy but had a non-sentinel node that was positive?

If the patient had a clinically negative axilla and otherwise meets criteria for Z0011, I would probably omit completion ALND in the setting of an incidentally identified non-sentinel node at the time of sentinel node biopsy. We know that the sentinel node biopsy carries a false negative rate of approximately 10%, and we certainly do not see axillary recurrence rates this high, so it appears that most patients with a falsely negative SLNB do not manifest with clinically relevant disease. So, I d...