What is the appropriate management of breast cancer patients with axillary nodal involvement based on imaging (MRI or ultrasound) but negative axillary nodal involvement based on physical exam?

If biopsy is not feasible, should these patient be treated as cN+ with neoadjuvant chemotherapy or as cN0 with upfront surgery with axillary sentinel node evaluation?

Answer from: Radiation Oncologist at Academic Institution

If concerning based on imaging, I would review with breast radiology expert to see if biopsy is possible, it's quite uncommon not to be biopsy. Also, regardless of the treatment approach (neoadjuvant chemo vs. upfront surgery), having a clip in the suspicious node is helpful to ensure it is removed ...

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Radiation Oncologist at Rush University Medical Center
20% of nodes are false positives and false negativ...

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What is the appropriate management of breast cancer patients with axillary nodal involvement based on imaging (MRI or ultrasound) but negative axillary nodal involvement based on physical exam?

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