Axillary Nodal Evaluation in Breast Cancer: State of the Art

Abstract

Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as nodenegative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.

Establishment and Validation of The Axillary Lymph Node Burden Using Cone-Beam Computerized Tomography and Ultrasound-Based Prediction Models in T1-2 Breast Cancer Patients

“…Chang et al (3) suggested that axillary imaging warrants consideration of at least axillary level I or II to examine lymphadenopathy. A degraded muscular status may be indicative of a shorter time of progression (34).…”

“…Because of its rapid progression and insidious symptoms in the early stage of biological invasion, breast cancer should be closely monitored with current advanced technology (2). The outcome of axillary lymph node dissection (ALND) plays an important role in the formulation and implementation of breast cancer regimens, including postoperative radiotherapy and chemotherapy (3). It is traditionally used for patients with metastatic sentinel lymph node (SLN) during surgery.…”

Predicting Axillary Lymph Node Status With a Nomogram Based on Breast Lesion Ultrasound Features: Performance in N1 Breast Cancer Patients

“…Axillary US is the primary method for evaluation of axillary nodes, especially in the evaluation of early ALN metastasis. Breast MRI can better demonstrate lymph node metastasis on higher stations (19). However, the use of axillary US in evaluating ALN has been limited by its moderate accuracy and considerable discrepancy among the studies.…”

Case Report: Intercostal Lymph Node Metastasis: A Case Report and Review of the Literature

“…The predominant lymphatic drainage pathway drains from the breast toward the axilla (1). However, nodal metastases outside the axilla may be present in up to 56% of breast cancer patients (2). The sites of extra-axillary nodes include the internal mammary lymph nodes, the infraclavicular region, the supraclavicular fossa, the interpectoral (Rotter's) space, and the breast itself.…”