Lymph Node Staging with US (and FNA)

  • Dominique FournierEmail author


Preoperative knowledge of regional lymph node status (N staging) is essential before planning a treatment for breast cancer. US is able to detect metastases smaller than 5 mm and to guide sampling, including for the internal mammary chain, without risk.

There is new evidence that in the absence of metastatic disease on US examination and US-guided fine-needle aspiration cytology (FNAC), axillary sentinel lymph node (surgical) biopsy (SLNB) and even axillary lymph node dissection (ALND) would be unnecessary because both are rarely positive for heavy metastatic burden, and therefore treatment options will not change.

Promoting this way of workup for patients with breast cancer would be beneficial for the patients, as compared to other imaging techniques and surgical procedures, in terms of irradiation, time to diagnosis, and treatment. Last but not least, the cheap US-guided FNAC is cost-effective, both for developing countries having restricted access to high-level technologies, such as MRI, PET/CT, and SLNB, and in First World countries which are faced with a permanent increase in health expenditure.

This chapter offers a current review of the methods for nodal staging assessment in breast cancer patients and underlines new frontiers for evaluation of small superficial lymph nodes with ultrasound such as the “avascularity” of a micrometastasis in the nodal cortex. The impact of intramammary nodes and internal (parasternal) mammary nodes are particularly discussed.


Breast cancer Sentinel lymph node Extra-axillary lymph node N staging Micrometastasis High-resolution ultrasonography US-guided FNA Harmonic imaging Elastography Color Doppler 



Axillary lymph node (surgical) dissection


Axillary ultrasound


Fine-Needle Aspiration


Lymph node


Sentinel node


Negative predictive value


Positive predictive value


Sentinel lymph node (surgical) biopsy




US-guided fine-needle aspiration biopsy (with core biopsy needle)


US-guided fine-needle aspiration cytology


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institut de radiologieSionSwitzerland

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