Under what circumstances would you pursue completion ALND in a patient with multiple positive sentinel nodes after breast-conserving surgery?

For clinical/imaging node-negative disease with 1-2 positive nodes, now there are 7 plus clinical studies (ACOSOG Z0011, AMAROS, OTOASOR, SENOMAC, IBCSG 23-01, AATRM, SINODAR-ONE) which have shown no difference in axillary recurrence, DFS with dissection, but higher lymphedema as expected. The most ...

Two randomized trials comparing outcomes for patients with a positive sentinel lymph node biopsy (SLNB) followed by axillary lymph node dissection (ALND) or no further axillary surgery allowed the entry of patients with more than 2 involved sentinel lymph node (SLN) metastases. The French SERC trial...