Ultrasound-guided marker clip placement and biopsy in level II axillary lymph nodes

Axillary lymph node staging is critical in breast cancer management, but localization of Level II nodes poses technical challenges due to their deep and variable anatomy. We present a case of a 39-year-old woman with invasive ductal carcinoma and isolated Level II axillary nodal metastases. Ultrasound-guided core biopsy with marker clip placement was performed on a lateral Level II node, while a medial Level II node was marked without biopsy. Preoperative wire localization was facilitated by these clips, enabling targeted surgical excision of the nodes. Surgical pathology confirmed residual metastatic involvement, and the patient proceeded with adjuvant therapy. This case highlights the utility of ultrasound-guided biopsy and marker clip placement for accurate localization and management of challenging Level II axillary nodes. Emerging localization technologies such as magnetic seed and radiofrequency identification (RFID) tags offer promising, radiation-free alternatives to wire-guided localization and may improve operative planning and patient outcomes. Further research is needed to standardize these techniques and validate long-term oncologic efficacy.