For patients with clinically node-negative disease, SLNB is an oncologically safe approach with less morbidity than ALND. The prospective IBCSG 23-01 trial of 934 patients randomized to completion of ALND (n = 465) or no ALND (n = 469), with median follow-up of 9.7 years, revealed that omitting ALND was safe, even if the sentinel nodes contained micrometastases [64]. The NSABP B-32 trial of 5,611 women randomized to SLNB alone versus axillary lymph node biopsy and ALND with follow-up of 8 years reported no statistical differences in overall survival, disease-free survival, and regional control with less postoperative morbidity in the SLNB alone group [2,3]. The Z0011 trial recruited 891 women with T1 or T2 invasive primary breast cancer and no palpable axillary adenopathy [5]. These women were randomized to SLNB versus ALND. The 10-year overall survival for patients treated with SLNB alone was noninferior to those treated with ALND. The Z0011 trial, with median follow-up of 9.3 years, also demonstrated no differences in survival between those who received ALND versus no ALND [5]. The After Mapping of the Axilla: Radiotherapy Or Surgery trial from the European Organization for Research and Treatment of Cancer with median follow-up of 10 years also showed no significant differences at 10 years for axillary recurrence or overall survival between the 2 groups [66]. CT Chest, Abdomen, and Pelvis Contrast-enhanced and noncontrast-enhanced CT studies are not typically performed for early-stage breast cancer in asymptomatic patients because asymptomatic distant disease is rare. Contrast-enhanced CT can be used if the primary breast cancer is >2 cm, there is clinical node-positive disease, the tumor demonstrates biologically Imaging of the Axilla aggressive features on histopathology, or patients present with clinical symptoms such as elevated liver function tests [7,92].
Imaging of the Axilla. For patients with clinically node-negative disease, SLNB is an oncologically safe approach with less morbidity than ALND. The prospective IBCSG 23-01 trial of 934 patients randomized to completion of ALND (n = 465) or no ALND (n = 469), with median follow-up of 9.7 years, revealed that omitting ALND was safe, even if the sentinel nodes contained micrometastases [64]. The NSABP B-32 trial of 5,611 women randomized to SLNB alone versus axillary lymph node biopsy and ALND with follow-up of 8 years reported no statistical differences in overall survival, disease-free survival, and regional control with less postoperative morbidity in the SLNB alone group [2,3]. The Z0011 trial recruited 891 women with T1 or T2 invasive primary breast cancer and no palpable axillary adenopathy [5]. These women were randomized to SLNB versus ALND. The 10-year overall survival for patients treated with SLNB alone was noninferior to those treated with ALND. The Z0011 trial, with median follow-up of 9.3 years, also demonstrated no differences in survival between those who received ALND versus no ALND [5]. The After Mapping of the Axilla: Radiotherapy Or Surgery trial from the European Organization for Research and Treatment of Cancer with median follow-up of 10 years also showed no significant differences at 10 years for axillary recurrence or overall survival between the 2 groups [66]. CT Chest, Abdomen, and Pelvis Contrast-enhanced and noncontrast-enhanced CT studies are not typically performed for early-stage breast cancer in asymptomatic patients because asymptomatic distant disease is rare. Contrast-enhanced CT can be used if the primary breast cancer is >2 cm, there is clinical node-positive disease, the tumor demonstrates biologically Imaging of the Axilla aggressive features on histopathology, or patients present with clinical symptoms such as elevated liver function tests [7,92].