Would you recommend axillary dissection for a patient with a clinically positive SCV or IMN node, who has a clinical CR to neoadjuvant chemo, but a positive SLNB?

My approach for this is to treat comprehensively with RT and boost any visible node/location where the prechemotherapy node existed and was not removed at surgery.

This is a great question that I have seen many times clinically. The point is often made that Z-11 did not include such patients and therefore the logic to omit ALND with limited SLN positivity is inappropriately applied. However, the true question may be whether radiation can eradicate disease in t...

With positive SLNB after neoadjuvant chemotherapy, I would favor dissection even if plan was to treat comprehensively afterwards. I understand that we don't dissect SCV or IMs routinely but standard practice has been to do ALND. I would boost undissected nodes in SCV/IM.