AB024. SOH26AB_0149. Optimising axillary staging in primary breast cancer: a comparative review of ultrasound and magnetic resonance imaging
Radiology Session

AB024. SOH26AB_0149. Optimising axillary staging in primary breast cancer: a comparative review of ultrasound and magnetic resonance imaging

Arun Ramnarine1, Kaja Czwojda1, Saqr Sami1, Gordon Daly1, Cian Hehir2, Arnold Hill2, Nuala Healy3

1Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Surgery, Beaumont Hospital, Dublin, Ireland; 3Department of Radiology, Beaumont Hospital, Dublin, Ireland

Background: One in 20 women will be diagnosed with breast cancer, making it the most globally prevalent malignancy. Axillary nodal status is its most valuable prognostic indicator, substantiating the importance of reliable evaluation to therapeutic planning. Current practice includes axillary ultrasound (US) in initial workup, often disregarding further exploration of this crucial region. Hence, the potential of more advanced modalities, namely magnetic resonance imaging (MRI), is seldom considered. This systematic review aimed to compare the diagnostic performance of US with MRI.

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, comprehensive searches were performed in online medical databases to identify relevant papers. The 1,759 identified studies were subsequently screened using predetermined inclusion criteria, with diagnostic performance as the primary outcome. Risk of bias was assessed using the RoB-1 tool. Data were extracted from thirty suitable studies, facilitating the descriptive synthesis of results.

Results: MRI, particularly with reconstructions and diffusion-weighted imaging, consistently demonstrated higher sensitivity than US. MRI also better characterised nodal morphology and detection of small-volume disease, especially for invasive lobular carcinoma. Conversely, the US remained more specific for identifying macrometastases, conducive to avoiding unnecessary surgery. This modality remained widely available and time-efficient across study settings. Integrated imaging (US followed by MRI) significantly refined overall diagnostic confidence. Cost, access, patient discomfort, and acquisition times were recurrent limitations for MRI.

Conclusions: MRI provides a more detailed and sensitive evaluation of axillary nodes, while US remains an accessible, efficient first-line tool. A tiered approach—US triage followed by MRI in indeterminate or high-risk patients—may optimise axillary staging and reduce overtreatment.

Keywords: Axillary staging; breast cancer; magnetic resonance imaging (MRI); radiology; ultrasound (US)

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab024
Cite this abstract as: Ramnarine A, Czwojda K, Sami S, Daly G, Hehir C, Hill A, Healy N. AB024. SOH26AB_0149. Optimising axillary staging in primary breast cancer: a comparative review of ultrasound and magnetic resonance imaging. Mesentery Peritoneum 2026;10:AB024.

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