It’s the Pits – Controversies in Imaging and Interventions in the Axilla

Sunday, April 14, 2024

9:30 AM – 10:00 AM

Location: 517

Moderator(s)

Jay A. Baker, MD, FACR, FSBI

Professor, Department of Radiology Vice Chair, Faculty Affairs & APT
Duke University Medical Center
Duke University Hospital

Slides PDF

Speaker(s)

Gary J. Whitman, MD, FSBI, FACR

Professor
University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center

Slides PDF
Vilert Loving, MD, MMM, FSBI

Chief of Breast Imaging
Banner MD Anderson Cancer Center
Isabelle Trop, MD MPH FRCPC

Centre Hospitalier de l'Université de Montréal
University of Montreal
CC

Christophe Cloutier Lambert, MD

Breast Radiologist
University of Montréal
Centre Hospitalier de l'Université de Montréal

We all wonder when we see a highly suspicious mass in the breast what - if anything - we should do with the axilla. Should we scan the axilla? Biopsy a lymph node? Leave a clip? What kind? Localize the node before surgery? What if I can't see it?! And what if the abnormal node is in a less-than-ideal location like level II or III axilla, internal mammary or supraclavicular? Come hear four experienced American and Canadian Breast Radiologists discuss their approaches to these questions and more as we follow a single patient from detection to diagnosis to treatment. We will state and defend our approaches to each scenario and discuss (and maybe debate) why we do what we do. You may agree. You may disagree. And by the end of the session, you may decide to change the way you approach the axilla.

Learning Objectives:

Upon completion, participants will develop a strategy of when to scan the axilla in the setting of a suspicious mass in the breast and will be able to recognize the morphologic signs that indicate a lymph node is suspicious. (hint: overall size of the lymph node isn't one of them.)
Upon completion, participants will understand the data supporting a strategy of whether (and how) to biopsy, place a clip, and/or localize an abnormal axillary lymph node in the setting of a suspicious mass in the breast.
Upon completion, participants will develop a plan for whether and how to biopsy lymph nodes in challenging locations, including level II and III axillary nodes, internal mammary and supraclavicular nodes. (hint: "Put this on my colleague's day" is not one of the solutions.)