A 58-year-old woman has a 22 mm irregular spiculated mass confirmed as invasive ductal carcinoma on left breast core biopsy. Axillary ultrasound shows a lymph node with an asymmetric cortex measuring 7 mm, displacing the fatty hilum eccentrically. What is the most appropriate next step?

• A Repeat axillary ultrasound after neoadjuvant chemotherapy
• B Proceed to surgery without axillary assessment since sentinel biopsy will be performed anyway
• C CT scan of chest and abdomen for distant staging first
• D Ultrasound-guided percutaneous sampling of the axillary node ✓

Explanation

Cortical thickening greater than 3 mm with displacement or effacement of the fatty hilum makes the node suspicious for metastasis, and percutaneous sampling confirms nodal status before surgery. D positive sampled node upgrades the patient to complete axillary clearance rather than sentinel biopsy alone, changing operative management. Waiting for post-chemotherapy imaging loses the pretreatment nodal stage, because chemotherapy alters nodal morphology.

Reference: ACR BI-RADS Atlas, Ultrasound Section, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.