CT Chest, Abdomen, and Pelvis Studies have shown that the use of advanced imaging modalities such as CT and FDG-PET/CT for staging asymptomatic women with early stage breast cancer has low yield for occult disease [44-46]. The 2020 NCCN Guidelines for Invasive Breast Cancer also suggest the use of CT with IV contrast only when there is elevated liver function tests, pulmonary or abdominal symptoms, or abnormal physical examination [7]. CT chest can visualize and assess the level I, II, and III regions of the axilla. The predictive accuracy of CT is not high enough to replace Imaging of the Axilla Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI for staging of the axilla in breast cancer patients. US Axilla Axillary US is often performed in early-stage breast cancer patients since the Z0011 trial showed that early-stage cancer and low nodal burden minimizes surgical morbidity because patients can undergo SLNB rather than ALND without compromising survival [5]. The other point of view supporting preoperative axillary US argues that the finding of an abnormal axillary node on axillary US followed by percutaneous biopsy confirmation would help to identify those patients with higher tumor burden [54,55], who would benefit from proceeding directly to ALND. This approach avoids the need for a Imaging of the Axilla second surgery. One study supporting the utilization of preoperative axillary US from a single center reported that only 3% to 5% of patients had an abnormal axillary US yet met the Z0011 criteria (ie, ALND was not necessary in these patients with preoperative abnormal axillary US). Other studies also supporting the use of preoperative axillary US even in patients who meet Z0011 criteria argue that axillary US can help identify patients with unsuspected extensive nodal disease, thereby removing them from consideration for unindicated SLNB [56-58].
Imaging of the Axilla. CT Chest, Abdomen, and Pelvis Studies have shown that the use of advanced imaging modalities such as CT and FDG-PET/CT for staging asymptomatic women with early stage breast cancer has low yield for occult disease [44-46]. The 2020 NCCN Guidelines for Invasive Breast Cancer also suggest the use of CT with IV contrast only when there is elevated liver function tests, pulmonary or abdominal symptoms, or abnormal physical examination [7]. CT chest can visualize and assess the level I, II, and III regions of the axilla. The predictive accuracy of CT is not high enough to replace Imaging of the Axilla Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI for staging of the axilla in breast cancer patients. US Axilla Axillary US is often performed in early-stage breast cancer patients since the Z0011 trial showed that early-stage cancer and low nodal burden minimizes surgical morbidity because patients can undergo SLNB rather than ALND without compromising survival [5]. The other point of view supporting preoperative axillary US argues that the finding of an abnormal axillary node on axillary US followed by percutaneous biopsy confirmation would help to identify those patients with higher tumor burden [54,55], who would benefit from proceeding directly to ALND. This approach avoids the need for a Imaging of the Axilla second surgery. One study supporting the utilization of preoperative axillary US from a single center reported that only 3% to 5% of patients had an abnormal axillary US yet met the Z0011 criteria (ie, ALND was not necessary in these patients with preoperative abnormal axillary US). Other studies also supporting the use of preoperative axillary US even in patients who meet Z0011 criteria argue that axillary US can help identify patients with unsuspected extensive nodal disease, thereby removing them from consideration for unindicated SLNB [56-58].