Considerations for the use of Preoperative Axillary Ultrasound in the Setting of a Suspicious Breast Mass in Light of the ACOSOG Z0011 Trial

Staging of the axilla is essential in breast cancer management as it has direct implications in prognosis and treatment. The ability to preoperatively diagnose metastatic axillary disease via ultrasound once had major clinical implications, as it allowed patients to proceed directly to axillary lymph node dissection, negating the need for a sentinel lymph node biopsy. However, this practice is evolving following the results of the American College of Surgeons Oncology Group Z0011 trial, which demonstrated some cases of limited metastatic axillary disease are eligible for a sentinel lymph node biopsy/targeted axillary dissection in lieu of the more invasive axillary lymph node dissection. These results call into question the benefit of utilizing axillary ultrasound for preoperative staging purposes.