Workup and staging of locally advanced breast cancer

This article reviews current approaches for workup and staging in patients with locally advanced breast cancer (LABC). Careful clinical examination and detailed imaging are discussed to accurately classify the extent of local, regional, and distant disease. Most patients with LABC receive neoadjuvant chemotherapy as initial treatment, and, in such patients, it is critical to accurately delineate the initial extent of disease because the initial clinical stage affects subsequent local-regional treatment decisions. Emphasis is placed on sonography, which is used extensively at the University of Texas M. D. Anderson Cancer Center for regional lymph node staging. Other modalities discussed in this article include mammography, magnetic resonance imaging, positron emission tomography (PET), and PET/computed tomography (CT). Conventional imaging (chest radiography, bone scan, and abdominal CT scans) techniques used in the evaluation of possible metastatic disease are discussed. In addition, the role of sentinel lymph node mapping in LABC patients is reviewed.