Optimal management of sentinel lymph node positive biopsy patients in early breast cancer

What is the optimal management of a positive sentinel lymph node (SLN) in patients with early stage breast cancer? Prior to the widespread adoption of SLN biopsy, axillary lymph node dissection (ALND) was considered to have both therapeutic and prognostic benefit. Multiple studies have shown the accuracy and predictive value of the SLN procedure (1) and randomized trials confirmed that patients with negative SLN could forgo ALND (2,3).