Future Directions in the Assessment of Axillary Lymph Nodes in Patients with Breast Cancer

Abstract

Background and Objectives: Breast cancer (BC) is a leading cause of morbidity and mortality worldwide, and accurate assessment of axillary lymph nodes (ALNs) is crucial for patient management and outcomes. We aim to summarize the current state of ALN assessment techniques in BC and provide insights into future directions. Materials and Methods: This review discusses various imaging techniques used for ALN evaluation, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography. It highlights advancements in these techniques and their potential to improve diagnostic accuracy. The review also examines landmark clinical trials that have influenced axillary management, such as the Z0011 trial and the IBCSG 23-01 trial. The role of artificial intelligence (AI), specifically deep learning algorithms, in improving ALN assessment is examined. Results: The review outlines the key findings of these trials, which demonstrated the feasibility of avoiding axillary lymph node dissection (ALND) in certain patient populations with low sentinel lymph node (SLN) burden. It also discusses ongoing trials, including the SOUND trial, which investigates the use of axillary ultrasound to identify patients who can safely avoid sentinel lymph node biopsy (SLNB). Furthermore, the potential of emerging techniques and the integration of AI in enhancing ALN assessment accuracy are presented. Conclusions: The review concludes that advancements in ALN assessment techniques have the potential to improve patient outcomes by reducing surgical complications while maintaining accurate disease staging. However, challenges such as standardization of imaging protocols and interpretation criteria need to be addressed. Future research should focus on large-scale clinical trials to validate emerging techniques and establish their efficacy and cost-effectiveness. Over-all, this review provides valuable insights into the current status and future directions of ALN assessment in BC, highlighting opportunities for improving patient care.

An exploratory study of whether axillary lymph node dissection can be avoided in breast cancer patients with positive lymph nodes

“…Sentinel lymph node metastasis means an increased risk of non-sentinel lymph node involvement, and the quantity of positive axillary lymph nodes is an independent influential element for the outcomes of breast cancer patients and is generally accepted by medical professionals ( 19 - 21 ). With the improvement of radiotherapy, chemotherapy, endocrine therapy and targeted therapy for breast cancer, multiple trials have discovered that residual tumors in axillary lymph nodes are less likely to worsen a patient’s prognosis, and ALND may even be avoided in certain populations.…”

A Pictorial Exploration of Mammary Paget Disease: Insights and Perspectives

“…Given their proficiency in extracting image characteristics, CNNs represent a specialized category of DL algorithms frequently employed for examining BC images [72]. These emerging advancements have demonstrated their potential to elevate the precision of imaging methodologies, thereby enhancing the management of patients with BC.…”