A small single-center study looking at the role of midtreatment axillary US in 159 patients of mixed breast cancer subtypes observed that US performed better for residual axillary nodal tumor burden than for residual index breast cancer and provided more consistent results across different cancer subtypes [109]. Variant 8: Female. Breast cancer, greater than 2 cm in size, clinical node-negative. Imaging of the axilla after completion of neoadjuvant chemotherapy. NAC is used to treat operable large tumors, nonoperable locally advanced tumors, and inflammatory breast cancers prior to definitive surgical management. If there is pathological response to NAC and the patient is clinically node- negative, SLNB is preferred over ALND in order to minimize morbidity. In a study of 925 patients treated with NAC, 5-year overall survival was superior for patients with pathologic complete remission of cytological proven axillary lymph node metastases (93%) compared with those without complete response (72%) [110]. The prognostic significance of response to NAC can vary between the primary breast tumor and the axilla and based on tumor receptor subtypes (eg, triple negative versus HER2 positive cancers) [112]. Those patients with initial node-positive breast cancer who achieve complete pathological response after NAC have similar prognoses as to those with clinical node-negativity [112]. Even though no imaging will replace SLNB or ALND for staging, the ability to assess response during or after NAC helps to predict outcomes and aids with treatment planning. CT Chest, Abdomen, and Pelvis There is no relevant literature to support the use of contrast-enhanced or noncontrast-enhanced CT to image the axilla after completion of NAC. Digital Breast Tomosynthesis Diagnostic There are no data to support the use of DBT to image the axilla after completion of NAC in patients with initial clinical node-negative disease and no new clinical concern or palpable axillary lump.
Imaging of the Axilla. A small single-center study looking at the role of midtreatment axillary US in 159 patients of mixed breast cancer subtypes observed that US performed better for residual axillary nodal tumor burden than for residual index breast cancer and provided more consistent results across different cancer subtypes [109]. Variant 8: Female. Breast cancer, greater than 2 cm in size, clinical node-negative. Imaging of the axilla after completion of neoadjuvant chemotherapy. NAC is used to treat operable large tumors, nonoperable locally advanced tumors, and inflammatory breast cancers prior to definitive surgical management. If there is pathological response to NAC and the patient is clinically node- negative, SLNB is preferred over ALND in order to minimize morbidity. In a study of 925 patients treated with NAC, 5-year overall survival was superior for patients with pathologic complete remission of cytological proven axillary lymph node metastases (93%) compared with those without complete response (72%) [110]. The prognostic significance of response to NAC can vary between the primary breast tumor and the axilla and based on tumor receptor subtypes (eg, triple negative versus HER2 positive cancers) [112]. Those patients with initial node-positive breast cancer who achieve complete pathological response after NAC have similar prognoses as to those with clinical node-negativity [112]. Even though no imaging will replace SLNB or ALND for staging, the ability to assess response during or after NAC helps to predict outcomes and aids with treatment planning. CT Chest, Abdomen, and Pelvis There is no relevant literature to support the use of contrast-enhanced or noncontrast-enhanced CT to image the axilla after completion of NAC. Digital Breast Tomosynthesis Diagnostic There are no data to support the use of DBT to image the axilla after completion of NAC in patients with initial clinical node-negative disease and no new clinical concern or palpable axillary lump.