How would you approach a patient that did not have preoperative axillary imaging and was found to have macromets on sentinel node biopsy, and on radiation planning scan has abnormal appearing nodes?

The patient is a female in her 50s with luminal B pT1b pN1(sn) invasive ductal carcinoma with 2/2 nodes, 5 mm ECE, and extensive LVI. No preoperative axillary imaging or cross-sectional imaging was performed.

The patient was found to have prominent axillary nodes on radiation planning scan. How would you approach this?

Answer from: Radiation Oncologist at Community Practice

Prominent node on planning CT is common after SNLN. However, in this situation based on the pathology, would favor sonogram and biopsy, and if positive, dissection followed by RT. The probability that the node is additional macromets is high based on the pathology.

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Radiation Oncologist at Delaware Valley Urology Cancer Treatment Center
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How would you approach a patient that did not have preoperative axillary imaging and was found to have macromets on sentinel node biopsy, and on radiation planning scan has abnormal appearing nodes?

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