Radioguided Surgery and Axillary Management in Breast Cancer: From Molecular Imaging to 3D Navigation Toward Personalized Treatment.
Authors
Affiliations (9)
Affiliations (9)
- Department of Nuclear Medicine, Hospital Universitario Dr. Peset, FISABIO, 46017 Valencia, Spain.
- Medical Oncology, Hospital Clínico Universitario de Valencia, INCLIVA, 46017 Valencia, Spain.
- Department of Nuclear Medicine, Hospital Clínico Universitario de Valencia, 46017 Valencia, Spain.
- Breast Surgery Unit, Hospital Clínico Universitario de Valencia, 46017 Valencia, Spain.
- Department of Nuclear Medicine, Hospital Universitario y Politécnico La Fe, 46017 Valencia, Spain.
- Department of Nuclear Medicine, Hospital Clínico San Carlos, 28040 Madrid, Spain.
- Department of Nuclear Medicine, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain.
- Department of Nuclear Medicine, Hospital Universitario Joan XXIII, 43005 Tarragona, Spain.
- Department of Nuclear Medicine, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
Abstract
Radioguided surgery has become a key component of contemporary breast cancer care, supporting less invasive approaches while maintaining oncologic safety. This narrative review summarizes current practice and recent developments in radioguided breast and axillary surgery, from established molecular imaging workflows to emerging three-dimensional and intraoperative technologies. Modern breast cancer management is increasingly shaped by tumor biology and the widespread use of neoadjuvant systemic therapy, which is transforming surgical decision-making and driving a shift toward personalized, patient-tailored pathways. In this context, radioguided techniques help maintain procedural accuracy despite therapy-induced changes in breast and nodal anatomy, enabling reliable lesion localization and targeted management of the axilla. We discuss sentinel lymph node strategies and de-escalation concepts, including targeted axillary dissection (TAD) after neoadjuvant therapy using marked nodes and selective removal approaches. We also review localization methods, including radioactive seed-based techniques, and the expanding role of molecular imaging-guided surgery to support intraoperative decision-making. Particular attention is paid to technologies aimed at improving surgical precision and margin assessment, including portable/freehand SPECT concepts and intraoperative PET/CT-based specimen imaging for immediate evaluation of excised tissue. Finally, we highlight how artificial intelligence and digital tools may enable workflow optimization, navigation, image interpretation, and decision support, accelerating the transition toward individualized treatment. Overall, integrating molecular information with real-time 3D guidance can help tailor breast and axillary management to each patient while reducing morbidity.