How would you manage a pT2N1a invasive ductal carcinoma s/p lumpectomy and sentinel lymph node biopsy with ECE, and two mildly avid axillary lymph nodes on post-op PET/CT?  

We often see mildly active lymph nodes on post-op PET/CT scans, so one important initial question is how long after the surgery the PET/CT was performed. Another question would be how many total lymph nodes were removed at the sentinel biopsy. If the scan was done ~6 weeks post-op and the patient ha...

Did the patient have a pre-surgery axillary sonogram? This is most likely reactive, but to confirm, I would favor a repeat axillary ultrasound and biopsy if it looks abnormal, as management will change if the patient has residual gross disease.

If the patient did not have a pre-op diagnostic CT or MRI, one thing that can be helpful is to look at the lymphoscintigraphy images if your institution obtains a CT. This can be particularly helpful if you see a suspicious IMN post-op on your sim and/or diagnostic imaging and didn't have a contrast...