Axillary Ultrasound Evaluation in Breast Cancer Patients: A Multidisciplinary Viewpoint and Middle Ground

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• A growing trend exists towards de-escalating axillary surgery in breast cancer management.
• Some patients may now avoid axillary lymph node dissection (ALND) or even sentinel lymph node biopsy (SLNB) despite positive results.
• Significant variability exists in imaging approaches for axillary lymph node assessment in breast cancer.

Purpose of the Study:

• To address the variability in axillary imaging for breast cancer.
• To propose a multidisciplinary approach for axillary nodal evaluation.
• To discuss the clinical impact and rationale for appropriate axillary nodal imaging.

Main Methods:

• Review of current trends in axillary surgery de-escalation.
• Discussion of multidisciplinary perspectives on axillary nodal evaluation.
• Development of a proposed imaging algorithm for axillary assessment.

Main Results:

• Identified wide variability in current axillary imaging practices.
• Highlighted the need for a standardized, multidisciplinary approach.
• Proposed an algorithm to guide axillary nodal imaging decisions.

Conclusions:

• A standardized, multidisciplinary approach to axillary nodal evaluation is needed.
• The proposed algorithm aims to optimize imaging strategies for breast cancer patients.
• Balancing clinical factors and imaging is crucial for appropriate axillary assessment.