However, there are no data to support the routine use of CT for assessing a new palpable axillary lump in breast cancer patients at midtreatment of NAC and very limited data on the use of CT for assessing nodal response. One retrospective study reviewed the pretreatment breast MRI, FDG-PET/CT, and CT imaging on 348 breast cancer patients who received NAC followed by surgery and reported that patients with higher radiological nodal stage on imaging were more likely to have node-positivity upon surgery, larger nodal metastases, and more frequent extranodal extension [108]. Digital Breast Tomosynthesis Diagnostic DBT allows visualization of axillary level I nodal regions but does not fully assess the axilla. Although not typically used for axillary evaluation, DBT may be helpful in evaluating for progression of the primary breast malignancy. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT for assessing a new palpable axillary mass during midtreatment of NAC. Mammography Diagnostic Similar to DBT, mammography does not visualize the entire axilla and is not useful for assessing an axillary lump. Mammography may be performed to determine if there is also progression of the primary breast carcinoma. Imaging of the Axilla MRI Breast There is no evidence to support the use of breast MRI as the initial imaging test for assessing a new palpable axillary lump during NAC treatment. However, breast MRI may be helpful in assessing response of the primary breast tumor and associated axillary adenopathy. Sestamibi MBI There is no relevant literature supporting the use of Tc-99m sestamibi MBI for assessing a new palpable axillary lump during midtreatment of NAC. US Axilla Despite the limited literature addressing the use of axillary US for assessing a new palpable axillary lump during midtreatment, axillary US may be useful in this scenario because of its noninvasive nature. If the axillary US finding is uncertain, biopsy can be performed [86].
Imaging of the Axilla. However, there are no data to support the routine use of CT for assessing a new palpable axillary lump in breast cancer patients at midtreatment of NAC and very limited data on the use of CT for assessing nodal response. One retrospective study reviewed the pretreatment breast MRI, FDG-PET/CT, and CT imaging on 348 breast cancer patients who received NAC followed by surgery and reported that patients with higher radiological nodal stage on imaging were more likely to have node-positivity upon surgery, larger nodal metastases, and more frequent extranodal extension [108]. Digital Breast Tomosynthesis Diagnostic DBT allows visualization of axillary level I nodal regions but does not fully assess the axilla. Although not typically used for axillary evaluation, DBT may be helpful in evaluating for progression of the primary breast malignancy. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT for assessing a new palpable axillary mass during midtreatment of NAC. Mammography Diagnostic Similar to DBT, mammography does not visualize the entire axilla and is not useful for assessing an axillary lump. Mammography may be performed to determine if there is also progression of the primary breast carcinoma. Imaging of the Axilla MRI Breast There is no evidence to support the use of breast MRI as the initial imaging test for assessing a new palpable axillary lump during NAC treatment. However, breast MRI may be helpful in assessing response of the primary breast tumor and associated axillary adenopathy. Sestamibi MBI There is no relevant literature supporting the use of Tc-99m sestamibi MBI for assessing a new palpable axillary lump during midtreatment of NAC. US Axilla Despite the limited literature addressing the use of axillary US for assessing a new palpable axillary lump during midtreatment, axillary US may be useful in this scenario because of its noninvasive nature. If the axillary US finding is uncertain, biopsy can be performed [86].