How would you manage a premenopausal woman with a poorly differentiated pT2 HR+/HER2- breast cancer and 3/3 SLNs with ITCs?

Assuming she was clinically N0 prior to surgery, I would not subject her to an ALND but would favor axillary radiation; since ITC is not considered 'node-positive' she doesn't meet criteria for the AMAROS trial but I would extrapolate the equivalence of axillary radiation to ALND from that study to ...