Evaluating the Role of Ultrasound in Axillary Staging for Breast Cancer: Insights from the AMAROS Trial

The AMAROS trial showed routine preoperative axillary ultrasound did not change sentinel lymph node positivity rates compared with clinical examination in early-stage breast cancer.

In a randomized cohort of approximately 4,806 patients with T1–T2, clinically node‑negative tumors, investigators compared preoperative axillary ultrasound versus clinical examination before sentinel lymph node biopsy (SLNB).

The trial directly tested whether imaging‑based triage would alter immediate operative management and found no significant difference in detection of sentinel lymph node involvement between approaches — supporting less reliance on routine ultrasound alone when planning intraoperative SLNB strategy.

Ultrasound use has been rising across practice settings to triage axillary management and to identify patients who might benefit from upfront axillary dissection or targeted sampling. Axillary ultrasound data from the trial indicate similar axillary tumor burden regardless of staging method, and increased ultrasound use did not reduce axillary dissections or materially change SLNB management in the randomized cohort.