In a retrospective study of 408 clinically node-positive breast cancer patients treated with NAC, the strongest predictor for residual axillary disease was preoperative US showing axillary lymphadenopathy, defined as axial cortical thickness >3.5 mm or loss of the hilum [125]. The prospective clinical Z1071 trial included 611 patients with US after NAC; US features associated with residual disease included increased cortical thickness (mean 3.5 mm), absent hilum, and longer lymph node diameter [126]. Monitoring Response to Neoadjuvant Chemotherapy US-Guided Core Biopsy Axillary Node There is no relevant literature to support the use of US-guided core biopsy of axillary nodes in initial imaging of the axilla after completion of NAC. US-Guided Fine Needle Aspiration Biopsy Axillary Node There is no relevant literature to support the use of US-guided FNA of axillary nodes in initial imaging of the axilla after completion of NAC. Variant 6: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Known breast cancer with clinical suspicion of metastatic disease. Staging or assessment of response to neoadjuvant chemotherapy. Initial imaging. Bone Scan Whole Body Staging of patients before and after treatment typically entails either 1) FDG-PET/CT skull base to mid-thigh only or 2) bone scan in conjunction with CT chest, abdomen, and pelvis with IV contrast, depending upon institutional preference. There is no evidence to support performing all 3 studies. Bone scan represents one of the standard imaging tests to stage a patient with newly diagnosed breast cancer, allowing assessment of bony metastasis. PET/CT combines cross-sectional imaging with tumor metabolism and has been shown to be more sensitive and accurate than conventional staging with combined CT and bone scan [127].
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. In a retrospective study of 408 clinically node-positive breast cancer patients treated with NAC, the strongest predictor for residual axillary disease was preoperative US showing axillary lymphadenopathy, defined as axial cortical thickness >3.5 mm or loss of the hilum [125]. The prospective clinical Z1071 trial included 611 patients with US after NAC; US features associated with residual disease included increased cortical thickness (mean 3.5 mm), absent hilum, and longer lymph node diameter [126]. Monitoring Response to Neoadjuvant Chemotherapy US-Guided Core Biopsy Axillary Node There is no relevant literature to support the use of US-guided core biopsy of axillary nodes in initial imaging of the axilla after completion of NAC. US-Guided Fine Needle Aspiration Biopsy Axillary Node There is no relevant literature to support the use of US-guided FNA of axillary nodes in initial imaging of the axilla after completion of NAC. Variant 6: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Known breast cancer with clinical suspicion of metastatic disease. Staging or assessment of response to neoadjuvant chemotherapy. Initial imaging. Bone Scan Whole Body Staging of patients before and after treatment typically entails either 1) FDG-PET/CT skull base to mid-thigh only or 2) bone scan in conjunction with CT chest, abdomen, and pelvis with IV contrast, depending upon institutional preference. There is no evidence to support performing all 3 studies. Bone scan represents one of the standard imaging tests to stage a patient with newly diagnosed breast cancer, allowing assessment of bony metastasis. PET/CT combines cross-sectional imaging with tumor metabolism and has been shown to be more sensitive and accurate than conventional staging with combined CT and bone scan [127].