Staging of breast cancer

Today, there are several imaging modalities available for staging newly diagnosed breast cancer. This evaluation to assess for the disease extent based on breast tumor size, lymph node involvement, and metastases using TMN system is needed to guide treatment, assess patients for clinical trials, and provide prognosis. Mammography remains the best imaging tool to evaluate for microcalcifications associated with the primary tumor, while MRI better demonstrates the tumor size and disease extent. Ultrasound is widely accepted as an adjunct to diagnostic mammography for the workup of breast masses and for image-guided biopsy. However, there is a growing utilization of axillary ultrasound for staging of the lymph node basins, as an adjunct to surgical staging with sentinel lymph node biopsy and/or axillary lymph node dissection. For assessment of possible distant metastases, PET in combination with CT provides the best overview or surveillance. These imaging modalities are all necessary for the radiologist to provide accurate primary tumor size, assess for regional nodal disease, and presence or absence of distant metastasis. This chapter discusses the different imaging modalities and their role in the staging workup of breast cancer.