Evaluation of patients for metastases prior to primary therapy

For axillary staging, preoperative US and needle biopsy have emerged as effective methods for triaging women with breast cancer directly to axillary surgery for SLNB or ALND or to neoadjuvant chemotherapy in those with axillary node-positive disease. However, there is no perfect modality to identify metastatic disease in breast cancer; every diagnostic test has its own advantages and limitations. The available evidence suggests routine evaluation for stage III and possibly stage II breast cancer using imaging techniques including FDG PET/CT. The workup of abnormal findings in breast cancer patients is by patient signs and symptoms including history and physical examination, laboratory tests, imaging, biopsy of suspicious finding in imaging studies, and monitoring serum markers.