Yoav Amitai MD, Presenter: Nothing to Disclose

Tehillah Menes MD, Abstract Co-Author: Nothing to Disclose

Orit Golan MD, PHD, Abstract Co-Author: Nothing to Disclose

Abnormal axillary lymph nodes on ultrasound are not a rare finding. We examined clinical and imaging characteristics, in order to define patients who may safely be followed.

Clinical, imaging and pathology data were collected for 167 consecutive patients who underwent sonogaphic guided needle biopsy of an abnormal lymph node between 2008 and 2013. Malignancy rates were examined for different clinical settings: palpable axillary mass; history of breast cancer; findings suggestive of a systemic disease; and those with a breast finding of low suspicion or an incidental abnormal axillary lymph node. Patients with known breast cancer and those with a highly suspicious breast mass were excluded.

Thirteen patients (8%) were found to have a malignant result (10-carcinoma; 2–lymphoma; 1-malignant spindle cell tumor). Malignancy increased with age (Mean age in those with benign pathology was 54 vs. 69 in malignancy, P<0.001).  Malignancy rates varied with clinical setting; Axillary mass (8, 26%); history of breast cancer (2, 11%); systemic disease (0%) and breast finding of low suspicion or incidental abnormal lymph node on screening (1, 1%). Malignancy was associated with lymph node size and cortical thickness. Low rates of malignancy were found when the cortex was<6mm (1, 0.8%). The most important imaging finding associated with malignancy was the lack of a preserved hilum, in which case almost a third (11, 31%) of the biopsies were malignant.

Only 1 of 85 women with a breast finding of low suspicion or an incidental abnormal axillary lymph node, was found to have malignancy. In this case the lymph node had no hilum. In women without breast cancer or a highly suspicious breast mass, more stringent criteria should be used when evaluating an abnormal axillary lymph node on sonography, as the malignancy rates are very low (1%).

In women being evaluated for breast findings, such as a low suspicion breast mass, and in those undergoing screening studies, the finding of an abnormal axillary lymph node does not usually require a needle biopsy as long as the lymph node has a preserved hilum and cortical thickness is under 6mm.

Amitai, Y, Menes, T, Golan, O, Do Women with an Abnormal Sonographic Axillary Lymph Node and no Breast Malignancy Need a Biopsy?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006982.html