Breast cancer is one of the most common cancers diagnosed in females. Adequate management of axillary lymph nodes in patients with breast cancer is important, as it impacts breast cancer survival. Imaging plays an important role in diagnosing and localizing metastatic axillary lymph nodes, particularly in light of growing evidence to de-escalate axillary surgery in early breast cancer patients. This chapter presents the imaging appearances and overview of staging and management of axillary lymph nodes in breast cancer, including the different ways to perform image-guided localization to aid accurate removal of metastatic lymph nodes.