US-Guided Core Biopsy Axillary Node There is no relevant literature to support the use of US-guided core biopsy of the axillary node in imaging of known axillary lymph node-positive breast cancer after completion of NAC. No imaging test can reliably detect residual nodal disease after NAC; therefore, surgical intervention (either sentinel node biopsy or axillary dissection) is necessary after completion of treatment, provided the patient demonstrated a PR or CR warranting surgery and did not undergo axillary surgery before treatment [112,137]. Some centers place a clip in the biopsied positive axillary node before treatment so that it can be surgically excised along with the sentinel node(s) after completion of the NAC; this procedure is sometimes referred to as targeted axillary dissection [138]. US-guided localization of the clipped lymph node can be performed preoperatively [139]. Excising the clipped lymph node and SLN(s) decreases the false-negative rate of SLN biopsy (SLNB) [140]. In a study of 31 patients, 11 patients had residual axillary disease, and, in all cases, the clipped lymph node was positive [141]. In a prospective study of 23 patients with clipped axillary metastases before NAC, the surgeon retrieved the clipped node in 22 cases, and the SLN was retrieved in only 19. The clipped node was the SLN in only 14 cases (61%). The NPV was 100% for removal of clipped and sentinel node but only 85% for SLN removal alone [119]. US-Guided Fine Needle Aspiration Biopsy Axillary Node There is no relevant literature to support the use of US-guided FNA of the axillary node in imaging of known axillary lymph node-positive breast cancer after completion of NAC.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. US-Guided Core Biopsy Axillary Node There is no relevant literature to support the use of US-guided core biopsy of the axillary node in imaging of known axillary lymph node-positive breast cancer after completion of NAC. No imaging test can reliably detect residual nodal disease after NAC; therefore, surgical intervention (either sentinel node biopsy or axillary dissection) is necessary after completion of treatment, provided the patient demonstrated a PR or CR warranting surgery and did not undergo axillary surgery before treatment [112,137]. Some centers place a clip in the biopsied positive axillary node before treatment so that it can be surgically excised along with the sentinel node(s) after completion of the NAC; this procedure is sometimes referred to as targeted axillary dissection [138]. US-guided localization of the clipped lymph node can be performed preoperatively [139]. Excising the clipped lymph node and SLN(s) decreases the false-negative rate of SLN biopsy (SLNB) [140]. In a study of 31 patients, 11 patients had residual axillary disease, and, in all cases, the clipped lymph node was positive [141]. In a prospective study of 23 patients with clipped axillary metastases before NAC, the surgeon retrieved the clipped node in 22 cases, and the SLN was retrieved in only 19. The clipped node was the SLN in only 14 cases (61%). The NPV was 100% for removal of clipped and sentinel node but only 85% for SLN removal alone [119]. US-Guided Fine Needle Aspiration Biopsy Axillary Node There is no relevant literature to support the use of US-guided FNA of the axillary node in imaging of known axillary lymph node-positive breast cancer after completion of NAC.