Implications of abnormal preoperative axillary imaging in the post Z011 era

We read the recent paper evaluating the benefit of preoperative axillary imaging in clinically node negative patients by Pilewskie et al. in the February 2016 issue of the Journal of the American College of Surgeons with great interest (1). The authors took an interesting approach to evaluate the role of axillary imaging, more specifically the role of abnormal axillary imaging in predicting the need for axillary lymph node dissection (ALND) in T1–T2 breast cancer patients who were deemed node negative by physical exam and managed according to ACOSOG Z011 criteria.