Purpose The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. Methods Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.

Purpose The prognostic importance of lymph node infiltration in breast cancer patients before and after neoadjuvant therapy has increased significantly in recent years. For that reason, the reliable detection of tumor-infiltrated axillary lymph nodes at the time of diagnosis plays a decisive role in further therapy. We therefore focused on the sensitivity of different pretherapeutic imaging modalities (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) in nodal positive breast cancer patients and aimed to find out whether cross-sectional imaging techniques (MRI, CT) could improve sensitivity for pretherapeutic axillary staging compared to conventional imaging such as mammography and sonography. Methods Breast cancer patients with tumor-infiltrated axillary lymph nodes between 2014 and 2020 having a surgery for breast cancer were included in the study. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Considering the increasing importance of neoadjuvant and post-neoadjuvant therapeutic algorithms, the reliable detection of tumor-infiltrated lymph nodes gains increasing importance. Only the safe detection of tumor-infiltrated lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy and thereby allows access to prognosis–improving post-neoadjuvant therapies.