Patients with negative preoperative axillary US and SLNB had fewer positive nodes, smaller nodal metastases, and lower extranodal extension on final pathology [58]. US-guided biopsy of any suspicious axillary node either via fine-needle aspiration (FNA) or core biopsy is commonly performed when preoperative axillary US is done. The sensitivity of US-guided biopsy is variable with a wide range of 52% to 90%, whereas the specificity is higher, ranging from 98% to 100% [59-63]. CT Chest, Abdomen, and Pelvis Even in women with clinical node-positive disease, contrast-enhanced CT is not routinely performed and is not a part of the initial staging assessment if the patient does not have any signs or symptoms of disease outside the breast. When adenopathy is seen on CT, the Hounsfield unit of the metastatic lymph node is likely higher than nonmetastatic nodes. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is a valuable modality with potential to impact clinical management of patients with newly diagnosed locally advanced disease, monitoring treatment response in patients with known metastatic breast cancer, and for detection of recurrent disease. FDG-PET/CT is not suggested for routine systemic staging in T0 to T3, N0 to 1, M0 breast cancer patients without signs or symptoms of metastatic disease. A meta-analysis of 25 studies demonstrates the inferiority of FDG-PET/CT to SLNB for evaluation of the axilla [49]. MRI Breast Dynamic contrast-enhanced MRI is useful for staging prior to systemic therapy and for restaging of the axilla after systemic therapy if the preoperative axillary staging was positive [7,48]. However, most of the data focuses on the tumor within the breast and not the axillary nodes.
Imaging of the Axilla. Patients with negative preoperative axillary US and SLNB had fewer positive nodes, smaller nodal metastases, and lower extranodal extension on final pathology [58]. US-guided biopsy of any suspicious axillary node either via fine-needle aspiration (FNA) or core biopsy is commonly performed when preoperative axillary US is done. The sensitivity of US-guided biopsy is variable with a wide range of 52% to 90%, whereas the specificity is higher, ranging from 98% to 100% [59-63]. CT Chest, Abdomen, and Pelvis Even in women with clinical node-positive disease, contrast-enhanced CT is not routinely performed and is not a part of the initial staging assessment if the patient does not have any signs or symptoms of disease outside the breast. When adenopathy is seen on CT, the Hounsfield unit of the metastatic lymph node is likely higher than nonmetastatic nodes. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is a valuable modality with potential to impact clinical management of patients with newly diagnosed locally advanced disease, monitoring treatment response in patients with known metastatic breast cancer, and for detection of recurrent disease. FDG-PET/CT is not suggested for routine systemic staging in T0 to T3, N0 to 1, M0 breast cancer patients without signs or symptoms of metastatic disease. A meta-analysis of 25 studies demonstrates the inferiority of FDG-PET/CT to SLNB for evaluation of the axilla [49]. MRI Breast Dynamic contrast-enhanced MRI is useful for staging prior to systemic therapy and for restaging of the axilla after systemic therapy if the preoperative axillary staging was positive [7,48]. However, most of the data focuses on the tumor within the breast and not the axillary nodes.