Mammography Diagnostic There is no relevant literature to support the use of diagnostic mammography in further evaluation of axillary imaging suspicious for metastatic disease. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections. MRI Breast Without and With IV Contrast There is no relevant literature to support the use of MRI breast with IV contrast in the further evaluation of axillary imaging suspicious for metastatic disease. Monitoring Response to Neoadjuvant Chemotherapy There is robust evidence to support MRI for determining extent of disease in the breast, both before and after NAC [1,4,31,32,35,36,43,63-66]. Although the axillary lymph nodes are included on MRI, it is only moderately sensitive for detection of axillary nodal metastasis before and after therapy [4,112,113]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast in the further evaluation of imaging suspicious for metastatic disease. US-Guided Core Biopsy Axillary Node US-guided axillary lymph node sampling is the most useful next study performed when axillary imaging is suspicious for metastatic disease [4]. Sampling of abnormal-appearing nodes by CNB is typically performed using a 14- to 18-gauge device. Some centers place a clip in the biopsied node to facilitate future image-guided localization of the lymph node at surgical excision after completion of NAC. US-guided CNB has proven high specificity, with a moderate to high sensitivity in the detection of metastatic lymph nodes. Houssami et al [33] published a meta-analysis of 2,874 FNA and CNB procedures and found a pooled sensitivity of 80%, a specificity of 98%, and a positive predictive value of 97%.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. Mammography Diagnostic There is no relevant literature to support the use of diagnostic mammography in further evaluation of axillary imaging suspicious for metastatic disease. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections. MRI Breast Without and With IV Contrast There is no relevant literature to support the use of MRI breast with IV contrast in the further evaluation of axillary imaging suspicious for metastatic disease. Monitoring Response to Neoadjuvant Chemotherapy There is robust evidence to support MRI for determining extent of disease in the breast, both before and after NAC [1,4,31,32,35,36,43,63-66]. Although the axillary lymph nodes are included on MRI, it is only moderately sensitive for detection of axillary nodal metastasis before and after therapy [4,112,113]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast in the further evaluation of imaging suspicious for metastatic disease. US-Guided Core Biopsy Axillary Node US-guided axillary lymph node sampling is the most useful next study performed when axillary imaging is suspicious for metastatic disease [4]. Sampling of abnormal-appearing nodes by CNB is typically performed using a 14- to 18-gauge device. Some centers place a clip in the biopsied node to facilitate future image-guided localization of the lymph node at surgical excision after completion of NAC. US-guided CNB has proven high specificity, with a moderate to high sensitivity in the detection of metastatic lymph nodes. Houssami et al [33] published a meta-analysis of 2,874 FNA and CNB procedures and found a pooled sensitivity of 80%, a specificity of 98%, and a positive predictive value of 97%.