However, when an FDG-avid axillary node is seen on a pretreatment PET/CT scan, this is highly predictive of metastasis [111]. Monitoring Response to Neoadjuvant Chemotherapy Mammography Diagnostic There is no relevant literature to support the use of diagnostic mammography in initial imaging evaluation of the axilla before NAC. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections. MRI Breast Without and With IV Contrast MRI does not always include the entire axilla and is not routinely used solely for evaluation of axillary lymph nodes. However, contrast-enhanced MRI may be useful for monitoring the breast and axillary response in clinically node- positive patients [4]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast in initial imaging evaluation of the axilla before NAC. US Axilla Axillary US is routinely performed for pretreatment evaluation of a clinically positive axilla [4]. Current National Comprehensive Cancer Network practice guidelines recommend axillary US and possible biopsy before starting systemic therapy [115]. US-guided FNA or CNB can confirm and mark metastatic disease. When US-guided biopsy confirms metastatic disease in pathologic-appearing nodes, it can obviate the need for pretreatment sentinel node biopsy because the completion of axillary surgery is typically performed after therapy [2,117]. Placing a biopsy clip to mark the metastatic lymph node before therapy can also help guide the type of axillary restaging surgery following NAC [119]. US-Guided Core Biopsy Axillary Node There is no evidence to support US-guided sampling as the initial imaging test for axillary lymph node evaluation.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. However, when an FDG-avid axillary node is seen on a pretreatment PET/CT scan, this is highly predictive of metastasis [111]. Monitoring Response to Neoadjuvant Chemotherapy Mammography Diagnostic There is no relevant literature to support the use of diagnostic mammography in initial imaging evaluation of the axilla before NAC. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections. MRI Breast Without and With IV Contrast MRI does not always include the entire axilla and is not routinely used solely for evaluation of axillary lymph nodes. However, contrast-enhanced MRI may be useful for monitoring the breast and axillary response in clinically node- positive patients [4]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast in initial imaging evaluation of the axilla before NAC. US Axilla Axillary US is routinely performed for pretreatment evaluation of a clinically positive axilla [4]. Current National Comprehensive Cancer Network practice guidelines recommend axillary US and possible biopsy before starting systemic therapy [115]. US-guided FNA or CNB can confirm and mark metastatic disease. When US-guided biopsy confirms metastatic disease in pathologic-appearing nodes, it can obviate the need for pretreatment sentinel node biopsy because the completion of axillary surgery is typically performed after therapy [2,117]. Placing a biopsy clip to mark the metastatic lymph node before therapy can also help guide the type of axillary restaging surgery following NAC [119]. US-Guided Core Biopsy Axillary Node There is no evidence to support US-guided sampling as the initial imaging test for axillary lymph node evaluation.