Axillary node status remains the most important prognostic factor in breast cancer, although axillary lymph node dissection (ALND) is increasingly questioned in patients with positive sentinel lymph nodes (SLN). The Memorial Sloan Kettering Cancer Center Van Zee nomogram may support decision-making regarding completion of ALND after positive SLN. This study evaluated the performance of the Van Zee model in 32 Algerian patients with cN0 breast cancer ≥ 4 cm (8 cT2 and 24 cT3) and positive SLN who underwent routine ALND. Using a 35% cut-off, the nomogram achieved 88.9% sensitivity, 78.2% specificity, and 84.3% accuracy, with positive and negative predictive values of 84.2% and 84.6%, respectively. The area under the receiver operating characteristic (ROC) curve was 0.85, indicating good discriminatory performance. Predictors of non-SLN involvement included lymphovascular invasion, luminal subtype, and a higher number of positive SLNs. Although predictive models for axillary invasion are well established, data from the Middle East and North Africa region remain limited. These findings suggest that the Van Zee nomogram is applicable to Algerian patients with breast tumours ≥ 4 cm without clinical axillary involvement. However, larger studies are required before definitive validation.