Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Abstract

Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.

Diagnostics and Therapeutics in Early Stage Breast Cancer Receiving Neoadjuvant Systemic Therapy

“…The role of MRI is also being highlighted, as although it has a lower spatial resolution, it provides an overview of the 'T', and of contralateral lymph node status. In another review work, Di Paola et al [8] gave an overview of image-guide techniques for localizing metastatic lymph nodes at diagnosis in patients who will be treated with NST. In the NST setting marking positive lymph nodes (LNs) at the time of diagnosis allows for their removal during post-NST surgery because the LNs at diagnosis do not always coincide with SLNs after NST.…”