Do you routinely perform an axillary ultrasound in women with newly diagnosed breast cancer without palpable axillary nodes?

The practice has changed a bit with Z11 and AMAROS. For all invasive cancer we do perform sonogram but ifthe nodes are not palpable but only suspicious on ultrasound we don't routinely perform a percutaneus bx. The idea is these patients are still suitable for SLNB and were included in Z11. SLNB would pick this node and if positive on SLNB the patient would get RT as part of BCS with axila included in the RT field for any additional microscopic disease. But if patient is going to get neoadjuvant chemotherapy then we do bx abnormal nodes seen on sonogram and put a clip in which is used for localization at the time of SLNB. Inserting a clip and localizing the node decreases false negative rates for SLNB after neoadjuvant chemotherapy.