CT Chest, Abdomen, and Pelvis There is no relevant literature to support the use of CT with or without intravenous (IV) contrast as an initial imaging test for palpable axillary mass. If systemic disease or nonmammary malignancy, such as lymphoma, is in the differential diagnosis, CT chest may be helpful to determine other areas of lymphadenopathy, as well as to assess for local bony, chest wall, or intrathoracic involvement. Digital Breast Tomosynthesis Diagnostic There is insufficient data to support the use of DBT as the initial imaging test for evaluating bilateral palpable axillary masses even though a portion of the axillary region can be visualized on DBT. DBT can provide global assessment of the breasts as well as assess for microcalcifications associated with the axillary mass(es). NCCN guidelines suggest that a diagnostic mammogram and/or DBT may complement axillary US by evaluating the breast for underlying lesions in the setting of patients presenting with axillary lymphadenopathy [7,21,32]. Imaging of the Axilla FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT as the initial imaging test for bilateral axillary adenopathy even though FDG-PET/CT can detect the axillary lymphadenopathy as well as other lymphadenopathy in the neck, chest, abdomen, and pelvis. In one series of breast cancer patients, FDG-PET/CT was significantly more accurate than US (75% versus 62%) for the detection of axillary lymph node metastases, but there was no difference in sensitivity (54% versus 38%) [38]. Incidental axillary FDG uptake on PET/CT may require further evaluation with mammography, DBT, and US, followed by possible image-guided biopsy. MRI Breast MRI of the breast is not routinely performed as the initial imaging assessment for bilateral palpable axillary masses. If digital mammography or DBT is negative for a primary breast malignancy in a patient with suspicious axillary lymphadenopathy, MRI can often identify the breast primary [34,35].
Imaging of the Axilla. CT Chest, Abdomen, and Pelvis There is no relevant literature to support the use of CT with or without intravenous (IV) contrast as an initial imaging test for palpable axillary mass. If systemic disease or nonmammary malignancy, such as lymphoma, is in the differential diagnosis, CT chest may be helpful to determine other areas of lymphadenopathy, as well as to assess for local bony, chest wall, or intrathoracic involvement. Digital Breast Tomosynthesis Diagnostic There is insufficient data to support the use of DBT as the initial imaging test for evaluating bilateral palpable axillary masses even though a portion of the axillary region can be visualized on DBT. DBT can provide global assessment of the breasts as well as assess for microcalcifications associated with the axillary mass(es). NCCN guidelines suggest that a diagnostic mammogram and/or DBT may complement axillary US by evaluating the breast for underlying lesions in the setting of patients presenting with axillary lymphadenopathy [7,21,32]. Imaging of the Axilla FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT as the initial imaging test for bilateral axillary adenopathy even though FDG-PET/CT can detect the axillary lymphadenopathy as well as other lymphadenopathy in the neck, chest, abdomen, and pelvis. In one series of breast cancer patients, FDG-PET/CT was significantly more accurate than US (75% versus 62%) for the detection of axillary lymph node metastases, but there was no difference in sensitivity (54% versus 38%) [38]. Incidental axillary FDG uptake on PET/CT may require further evaluation with mammography, DBT, and US, followed by possible image-guided biopsy. MRI Breast MRI of the breast is not routinely performed as the initial imaging assessment for bilateral palpable axillary masses. If digital mammography or DBT is negative for a primary breast malignancy in a patient with suspicious axillary lymphadenopathy, MRI can often identify the breast primary [34,35].