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 ( Z11, AMAROS, OTASAR, SENOMAC, IBCSG, AATRM, SINODAR one) which have shown no difference in axillary recurrence, DFS with dissection but higher lymphedema as expected . Most recent one and...