What is the appropriate management of breast cancer patients with axillary nodal involvement based on imaging (MRI or ultrasound) but negative axillary nodal involvement based on physical exam?

If concerning based on imaging, I would review with breast radiology expert to see if biopsy is possible, it's quite uncommon not to be biopsy. Also, regardless of the treatment approach (neoadjuvant chemo vs. upfront surgery), having a clip in the suspicious node is helpful to ensure it is removed ...