Completion ALND in patients with a positive SLN

The need for completion ALND in patients with a positive SLN who will receive systemic cytotoxic therapy is also controversial. Our data show that in 52% of patients the sentinel node is the only positive node (70). On multivariate analysis, the number of positive sentinel nodes removed and the size of metastasis in the SLN were significant positive predictors for additional positive nodes in the axilla, while the number of negative sentinel nodes removed was a significant negative predictor. Unfortunately, neither of these characteristics, alone or in combination, was a strong enough predictor of non-sentinel lymph node tumour involvement to identify a subset of patients who can safely forgo completion ALND (70). As a result, the role of completion ALND in these patients is controversial. This important clinical question is being addressed by the ACOSOG Z0011 trial (Table 1). In this trial, patients with a positive SLN are randomised to completion ALND or no additional axillary therapy.

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