In a meta-analysis of 9 retrospective studies, MRI detected an occult breast cancer in more than two-thirds of patients [39]. MRI can also help further characterize the axillary mass(es) by determining involvement of adjacent vessels, the chest wall, and other axillary structures. Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI as the initial imaging of patients presenting with bilateral palpable axillary masses. Variant 3: Female. Newly diagnosed breast cancer, 2 cm or less, with clinical node-negative. Initial imaging of the axilla following diagnostic mammography or DBT. Regional nodal staging is an important prognostic factor in guiding the treatment of breast cancer, which has undergone significant change over the last decade [42,43]. Historically, ALND was the standard of care for staging the nodal region and providing local control of breast cancer that has metastasized to regional nodes. The result of the Z0011 trial changed the approach to axillary disease management [5]. 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 Z0011 patients treated with SLNB alone was noninferior to those treated with ALND [4]. Therefore, SLNB became a safe alternative to ALND for clinically node-negative breast cancer patients, with a less invasive approach and less morbidity. In 2014, the American Society of Breast Surgeons published consensus guideline on the management of the axilla in which SLNB has replaced ALND for clinically node-negative invasive breast cancer patients [6]. It is desirable to identify those patients who can safely receive SLNB and those who we can potentially omit SLNB. However, there is no standard radiologic imaging test for this purpose and this remains an area of controversy.
Imaging of the Axilla. In a meta-analysis of 9 retrospective studies, MRI detected an occult breast cancer in more than two-thirds of patients [39]. MRI can also help further characterize the axillary mass(es) by determining involvement of adjacent vessels, the chest wall, and other axillary structures. Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI as the initial imaging of patients presenting with bilateral palpable axillary masses. Variant 3: Female. Newly diagnosed breast cancer, 2 cm or less, with clinical node-negative. Initial imaging of the axilla following diagnostic mammography or DBT. Regional nodal staging is an important prognostic factor in guiding the treatment of breast cancer, which has undergone significant change over the last decade [42,43]. Historically, ALND was the standard of care for staging the nodal region and providing local control of breast cancer that has metastasized to regional nodes. The result of the Z0011 trial changed the approach to axillary disease management [5]. 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 Z0011 patients treated with SLNB alone was noninferior to those treated with ALND [4]. Therefore, SLNB became a safe alternative to ALND for clinically node-negative breast cancer patients, with a less invasive approach and less morbidity. In 2014, the American Society of Breast Surgeons published consensus guideline on the management of the axilla in which SLNB has replaced ALND for clinically node-negative invasive breast cancer patients [6]. It is desirable to identify those patients who can safely receive SLNB and those who we can potentially omit SLNB. However, there is no standard radiologic imaging test for this purpose and this remains an area of controversy.