MRI Breast Breast MRI is a highly sensitive imaging modality for assessing disease within the breast [156,157]. There are no data to support breast MRI as the initial imaging test of the axilla in patients with newly diagnosed locally recurrent breast cancer to evaluate for additional nodal disease. The MRI may be ordered after the mammogram or DBT to evaluate additional recurrent disease or disease extent within the breast not completely seen on mammogram or DBT [158]. An observational cohort study of 13,266 women and a single-center study of 1,521 women reported higher cancer detection rate with MRI compared with mammography [156,157]. Sestamibi MBI There is no relevant literature supporting the use of Tc-99m sestamibi MBI for imaging the axilla in patients with newly diagnosed recurrent disease. US Axilla US can be used to evaluate the axilla in patients with newly diagnosed recurrent breast cancer after BCS, after mastectomy, or with suspicion of recurrent nodal disease in the axilla. Diagnostic mammogram and/or DBT to evaluate for in-breast recurrent disease has also been shown to be helpful [154]. Axillary US can also provide guidance for percutaneous biopsy of any suspicious nodes because it influences potential surgical approach (SLNB versus full ALND). Variant 11: Female. Suspicious axillary node on mammography or ultrasound. Next imaging study. CT Chest, Abdomen, and Pelvis CT is not frequently used to assess abnormal axillary nodes detected on US or mammography; however, it is often used to evaluate a biopsy-proven nonbreast malignant axillary node. One study with 297 patients from two centers found no change in the number of second axillary surgeries between patients who received a CT scan of their axilla versus those who did not [47]. There are little data to support the use of contrast- or noncontrast-enhanced CT for this indication if there is no clinical suspicion of additional systemic disease.
Imaging of the Axilla. MRI Breast Breast MRI is a highly sensitive imaging modality for assessing disease within the breast [156,157]. There are no data to support breast MRI as the initial imaging test of the axilla in patients with newly diagnosed locally recurrent breast cancer to evaluate for additional nodal disease. The MRI may be ordered after the mammogram or DBT to evaluate additional recurrent disease or disease extent within the breast not completely seen on mammogram or DBT [158]. An observational cohort study of 13,266 women and a single-center study of 1,521 women reported higher cancer detection rate with MRI compared with mammography [156,157]. Sestamibi MBI There is no relevant literature supporting the use of Tc-99m sestamibi MBI for imaging the axilla in patients with newly diagnosed recurrent disease. US Axilla US can be used to evaluate the axilla in patients with newly diagnosed recurrent breast cancer after BCS, after mastectomy, or with suspicion of recurrent nodal disease in the axilla. Diagnostic mammogram and/or DBT to evaluate for in-breast recurrent disease has also been shown to be helpful [154]. Axillary US can also provide guidance for percutaneous biopsy of any suspicious nodes because it influences potential surgical approach (SLNB versus full ALND). Variant 11: Female. Suspicious axillary node on mammography or ultrasound. Next imaging study. CT Chest, Abdomen, and Pelvis CT is not frequently used to assess abnormal axillary nodes detected on US or mammography; however, it is often used to evaluate a biopsy-proven nonbreast malignant axillary node. One study with 297 patients from two centers found no change in the number of second axillary surgeries between patients who received a CT scan of their axilla versus those who did not [47]. There are little data to support the use of contrast- or noncontrast-enhanced CT for this indication if there is no clinical suspicion of additional systemic disease.