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

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.

Automated summary

Targeted axillary dissection (TAD) is an axillary staging technique that involves removing confirmed metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT). It has lower false-negative rates and avoids the complications of traditional axillary lymph node dissection. Therefore, marking positive axillary lymph nodes before NACT is crucial. Various localization methods such as clip placement, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices are available. This paper aims to explain the management of axillary lymph nodes based on guidelines and discuss the features, advantages, and disadvantages of axillary lymph node markers.