Limited data have suggested that the sensitivity of axillary US is higher for some subtypes such as triple negative breast cancer (69%) and HER2 positive breast cancer (71%) [140,141]. This discussion is based on the understanding that patients post-BCS or postmastectomy with reconstruction have likely already undergone a diagnostic mammogram or DBT to evaluate for or rule out in-breast recurrent disease. Therefore, the possible next imaging test or initial imaging test for the axilla are discussed below for each modality. Imaging of the Axilla CT Chest, Abdomen, and Pelvis There are no data to support the utilization of CT for axillary node assessment in the setting of newly diagnosed in- breast recurrent disease or as the initial imaging test for the axilla. However, CT can be performed concurrently at the time of the locally recurrent breast cancer diagnosis to rule out distant metastatic disease and for pretreatment planning. CT allows visualization of any chest wall involvement as well as the relationship of the recurrent disease to regional vital structures such as axillary artery and vein [7,92,154]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may be ordered concurrently at the time of the locally recurrent breast cancer diagnosis to rule out distant metastatic disease and for pretreatment planning. PET/CT is helpful in identifying unsuspected regional nodal disease or distant metastases in certain situations such as in patients with locally advanced breast cancer and inflammatory breast cancer [7]. In a meta-analysis of 26 studies involving 1,752 patients with suspected recurrent breast cancer, the pooled sensitivity for FDG-PET/CT was 90% and specificity was 81%; FDG-PET/CT is more accurate than PET alone [155]. The authors noted that the studies were heterogeneous, and therefore the analysis had limitations. In-breast recurrent disease versus chest wall or nodal recurrent disease was not specified [155].
Imaging of the Axilla. Limited data have suggested that the sensitivity of axillary US is higher for some subtypes such as triple negative breast cancer (69%) and HER2 positive breast cancer (71%) [140,141]. This discussion is based on the understanding that patients post-BCS or postmastectomy with reconstruction have likely already undergone a diagnostic mammogram or DBT to evaluate for or rule out in-breast recurrent disease. Therefore, the possible next imaging test or initial imaging test for the axilla are discussed below for each modality. Imaging of the Axilla CT Chest, Abdomen, and Pelvis There are no data to support the utilization of CT for axillary node assessment in the setting of newly diagnosed in- breast recurrent disease or as the initial imaging test for the axilla. However, CT can be performed concurrently at the time of the locally recurrent breast cancer diagnosis to rule out distant metastatic disease and for pretreatment planning. CT allows visualization of any chest wall involvement as well as the relationship of the recurrent disease to regional vital structures such as axillary artery and vein [7,92,154]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may be ordered concurrently at the time of the locally recurrent breast cancer diagnosis to rule out distant metastatic disease and for pretreatment planning. PET/CT is helpful in identifying unsuspected regional nodal disease or distant metastases in certain situations such as in patients with locally advanced breast cancer and inflammatory breast cancer [7]. In a meta-analysis of 26 studies involving 1,752 patients with suspected recurrent breast cancer, the pooled sensitivity for FDG-PET/CT was 90% and specificity was 81%; FDG-PET/CT is more accurate than PET alone [155]. The authors noted that the studies were heterogeneous, and therefore the analysis had limitations. In-breast recurrent disease versus chest wall or nodal recurrent disease was not specified [155].