LAUSR

It is well-established that axillary lymph node dissection (ALND) does not improve the rates of local recurrence or survival among clinically node-negative women with two or fewer positive sentinel nodes. Given the morbidity associated with ALND and its deleterious impact on quality of life, there is increasing interest in identifying clinically node-positive patients in whom ALND may be safely omitted. Historically, palpable adenopathy has been regarded as a surrogate for high-volume nodal disease and is considered to be an indication for ALND unless nodal pathologic complete response (pCR) is obtained with neoadjuvant systemic therapy; however, rates of nodal pCR do not exceed 35% among women with hormone receptorpositive (HR?) and human epidermal growth factor receptor 2-negative (HER2-) tumors. As a result, women with HR?/HER2tumors and palpable adenopathy frequently require ALND, even after neoadjuvant systemic therapy. In the modern era, the proportion of women with palpable adenopathy and low-volume nodal disease at presentation who might avoid ALND with initial surgery is unknown. PRESENT