Mougnyan Cox MD, Presenter: Nothing to Disclose

Upasana Joneja MD, Abstract Co-Author: Nothing to Disclose

Angela Hou, Abstract Co-Author: Nothing to Disclose

Rashmi Balasubramanya MD, Abstract Co-Author: Nothing to Disclose

Tara Raquel Eisenberg MD, Abstract Co-Author: Nothing to Disclose

Annina Nicholas Wilkes MD, Abstract Co-Author: Nothing to Disclose

Axillary lymphadenopathy (ALD) in the setting of an otherwise normal screening mammogram may be benign or malignant in etiology. While several authors have investigated the clinical relevance of ALD, no study has addressed the implications of unilateral versus bilateral ALD. In our study, unilateral and bilateral ALD were studied separately in an attempt to further risk-stratify patients for subsequent work-up.

After Institutional Board Review approval, a retrospective review of screening mammograms at our institution from the year 2006 to 2013 was performed. Patients with isolated ALD were classified according to whether ALD was unilateral or bilateral. Ultrasound examination of the axilla was recommended in all cases with ALD. Further clinical history obtained from the primary care provider and patient records.  Most patients were subsequently referred for biopsy after final interpretation of mammogram and ultrasound. Biopsy results were reviewed when available. 

65 patients with ALD and otherwise normal mammograms were identified. 54 patients returned for subsequent work-up. Of the 54 patients,19 (35%) had bilateral ALD and 35 (65%) had unilateral ALD.  In the patients with bilateral ALD, 10 out of 19 cases (53%) were due to malignancy, all of which were hematologic (lymphoma).  The most common hematologic malignancy was chronic lymphocytic leukemia (CLL), found in 8 out of 19 patients with bilateral ALD.  No cases of occult breast metastases were found in patients with bilateral ALD.  There were 8 patients with bilateral ALD over the age of 60, and every single case was due to lymphoma. 35 patients had unilateral ALD, of which 8 cases (23%) were due to malignancy. The most common malignancy was occult breast metastasis, found in 5 patients (14%).  The other 3 patients with malignant unilateral ALD had lymphoma. 

Bilateral ALD appeared to have a higher risk of malignancy, mostly hematologic. Unilateral ALD had a lower risk of malignancy overall, but most of the malignancies in this group were occult breast metastases. Patients over the age of 60 presenting with bilateral ALD have a high risk of lymphoma, and biopsy should be pursued in all cases.

Bilateral lymphadenopathy on screening mammography has a high incidence of hematologic malignancy, particularly in patients over the age of 60.

Cox, M, Joneja, U, Hou, A, Balasubramanya, R, Eisenberg, T, Wilkes, A, Isolated Axillary Lymphadenopathy on Screening Mammography: Does Unilateral versus Bilateral Matter? Experience at a Tertiary-care Referral Center with Radiologic-pathologic Correlation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001497.html