E4572. Axillary Evaluation in Newly Diagnosed Breast Cancer
Authors
Risha Shah;
Barnes Jewish Hospital; Mallinkrodt Institute of Radiology
Ashley Wilbers;
Barnes Jewish Hospital; Washington University in St. Louis School of Medicine
Michelle Lee;
Mallinkrodt Institute of Radiology; Washington University in St. Louis School of Medicine
Debbie Bennett;
Mallinkrodt Institute of Radiology; Washington University in St. Louis School of Medicine
Background
Preoperative axillary lymph node staging in the setting of newly diagnosed breast cancer has traditionally been regarded as critical for determining prognosis as well as guiding treatment decisions. Widespread adoption of sentinel lymph node biopsy over full axillary lymph node dissection (ALND) has resulted in some practices questioning the utility of preoperative axillary imaging. At the same time, neoadjuvant therapy has become more commonly recommended for a variety of indications, including biopsy-proven nodal metastatic disease. As treatment decisions become more complex and multi-disciplinary, it is important for the radiologist to understand historical, current and future trends in oncologic axillary evaluation as well as treatment, in order to help guide clinical management decisions.
Educational Goals / Teaching Points
In addition to reviewing the abnormal morphological appearance of lymph nodes, axillary anatomy, nodal staging, and the multiple modalities that can be used to evaluate the axilla, trends in oncologic axillary treatment (including the groundbreaking Z0011 trial) will also be examined. Arguments both for and against preoperative axillary evaluation will be provided. Caveats regarding axillary evaluation in those patients undergoing neoadjuvant chemotherapy or who are planning to undergo mastectomy will also be summarized.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Much of the research and recommendations regarding the utility and need for preoperative axillary imaging in the setting of newly diagnosed breast cancer has emerged only in the past decade and continues to evolve rapidly. Any radiologist involved in reading breast imaging or treating newly diagnosed breast cancer patients should be informed about the multiple perspectives on oncologic axillary evaluation so as to best individualize and optimize care within this population.
Conclusion
Axillary evaluation in the setting of newly diagnosed breast cancer is a highly contentious and ever-evolving field of interest in Breast Radiology. There are trade-offs between accurately diagnosing metastatic adenopathy and reducing unnecessary exams and biopsies for patients.
