When it is not necessary to remove all lymph nodes

Axillary Lymph Node Dissection (ALND) should be performed under the following conditions:

• Adequate tumor-specific adjuvant systemic therapy is not being conducted or planned.
• Segmental breast resection without adjuvant whole breast irradiation.
• After neoadjuvant therapy.
• Mastectomy without planned PMRT (post-mastectomy radiation therapy).
• Clinical, palpable, or radiological (ultrasound/MRI) suspicion of the presence of other suspicious lymph nodes, in addition to sentinel lymph nodes.
• Clinical, palpable, or radiological (ultrasound/MRI) suspicion of more than 2 suspicious lymph nodes pT3.

In other cases, ALND may not be necessary.