Contrast-enhanced CT may be used if the primary breast cancer is >2 cm, there is clinical node-positive disease, the tumor demonstrates biologically aggressive features on histopathology, or patients present with clinical symptoms such as elevated liver function tests [7,92]. However, findings on CT do not influence the approach for axillary surgery, reduce the number of axillary surgeries, or reduce the reoperation rate [14,47]. For locally advanced breast cancer (>5 cm in size, involving skin or underlying chest wall) and local recurrence, CT may be helpful [7]. For inflammatory breast cancer, the incidence of nodal metastases at presentation is high, up to 79.8% in a SEER registry of 761 patients and 5-year survival is worse for lymph node-positive patients (49%) than node-negative patients (66%) [98]. If there is clinical suspicion of inflammatory breast cancer, contrast-enhanced CT may be helpful for staging [7]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may be useful in the staging of newly diagnosed advanced breast cancer given a higher likelihood of extra-axillary metastatic disease or distant disease [94,95]. It has been proposed that if a primary breast tumor is >2 cm and has a high SUVmax, there is a higher probability of axillary nodal metastases [73,99]. In addition to assisting in the staging of advanced breast cancer, FDG-PET/CT may be beneficial in staging patients with T1 stage breast cancer, particularly those with triple negative or human epidermal growth factor receptor 2 (HER2) positive breast cancer with clinical node positive disease because there is a higher prevalence of nodal disease and distant metastases [71]. In order to assess response to neoadjuvant therapy, comparing pretreatment nodal FDG uptake to subsequent midtreatment or post-treatment FDG uptake is essential and also can be used to identify those at a higher risk of recurrence [100-102].
Imaging of the Axilla. Contrast-enhanced CT may be used if the primary breast cancer is >2 cm, there is clinical node-positive disease, the tumor demonstrates biologically aggressive features on histopathology, or patients present with clinical symptoms such as elevated liver function tests [7,92]. However, findings on CT do not influence the approach for axillary surgery, reduce the number of axillary surgeries, or reduce the reoperation rate [14,47]. For locally advanced breast cancer (>5 cm in size, involving skin or underlying chest wall) and local recurrence, CT may be helpful [7]. For inflammatory breast cancer, the incidence of nodal metastases at presentation is high, up to 79.8% in a SEER registry of 761 patients and 5-year survival is worse for lymph node-positive patients (49%) than node-negative patients (66%) [98]. If there is clinical suspicion of inflammatory breast cancer, contrast-enhanced CT may be helpful for staging [7]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may be useful in the staging of newly diagnosed advanced breast cancer given a higher likelihood of extra-axillary metastatic disease or distant disease [94,95]. It has been proposed that if a primary breast tumor is >2 cm and has a high SUVmax, there is a higher probability of axillary nodal metastases [73,99]. In addition to assisting in the staging of advanced breast cancer, FDG-PET/CT may be beneficial in staging patients with T1 stage breast cancer, particularly those with triple negative or human epidermal growth factor receptor 2 (HER2) positive breast cancer with clinical node positive disease because there is a higher prevalence of nodal disease and distant metastases [71]. In order to assess response to neoadjuvant therapy, comparing pretreatment nodal FDG uptake to subsequent midtreatment or post-treatment FDG uptake is essential and also can be used to identify those at a higher risk of recurrence [100-102].