Would you recommend axillary lymph node dissection in a pre-menopausal woman with ER+ PR+ HER2- IDC, s/p lumpectomy and SLN with pT1c pN1 cM0 disease, where 2 sentinel nodes are positive for macrometastasis and 1 SN is positive for micrometastasis?   

ACOSOG Z0011 study showed that locoregional control, in patients with low to moderate axillary tumor burden treated with breast-conserving therapy and adjuvant systemic therapy, may not be improved by ALND after SLND compared to SLND alone. In ACOSOG Z0011, the detection of SN metastases was made ba...