Local and regional staging of invasive breast cancer with sonography: 25 years of practice at MD Anderson Cancer Center

At TheUniversity of Texas MD Anderson Cancer Center, wehave used sonography (US) extensively for more than 2 decades to refine the local and regional staging of invasive breast cancer. Although magnetic resonance imaging is superior to all other imaging modalities in the measurement of the primary tumor anddetectionof additional foci ofmalignancy, in our experience US has shown sufficient accuracy in clinical practice to stage most invasive breast cancers. The exceptions are ill-defined tumors such as invasive lobular cancers and tumors in breasts containing extensive diffuse benign disease. An advantage of US is that multifocality ormulticentricity can be confirmed via US guided fine-needle aspiration within 15 minutes and the information shared immediately with the patientand the breast surgeon or medical oncologist. US has alsoprovedindispensable in the evaluation of lymphatic spread because it can evaluate more nodal basins (e.g., the supraclavicular fossa and low neck) than magnetic resonance imaging can and because it can guide needle biopsy to confirm the status of any indeterminate node (including internal mammary nodes) within minutes.