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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Adenopathy: Morphologically abnormal axillary lymph node(s)
- Axillary lymph node dissection (ALND): Surgical removal of axillary contents (fat and lymph nodes) for staging breast cancer and local disease control
- Sentinel lymph node (SLN): 1st/primary draining node(s); biopsy for staging clinically node-negative breast cancer
- Cross metastases = Axillary nodal metastases from contralateral breast cancer
- Controversial: Stage IV, but may behave as regional disease when occurs as part of recurrence with disrupted lymphatic drainage
- Must exclude ipsilateral primary breast cancer
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Grimm LJ et al: Normal axillary lymph node variability between white and black women on breast MRI. Acad Radiol. 25(3):305-308, 2018
- Le-Petross HT et al: Axillary ultrasound identifies residual nodal disease after chemotherapy: Results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). AJR Am J Roentgenol. 210(3):669-676, 2018
- Farrokh D et al: Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound. Case Rep Obstet Gynecol. 2017:4807013, 2017
- Gajaria PK et al: Fibroadenoma in Axillary Ectopic Breast Tissue Mimicking Lymphadenopathy. J Clin Diagn Res. 11(3):ED01-ED02, 2017
- Gupta A et al: Review of axillary lesions, emphasising some distinctive imaging and pathology findings. J Med Imaging Radiat Oncol. ePub, 2017
- Lim HS et al: Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. J Ultrasound Med. ePub, 2017
- Klang E et al: Association between Enlarged Axillary Lymph Nodes and Silicone Breast Implant Ruptures seen on Magnetic Resonance Imaging. Isr Med Assoc J. 18(12):719-724, 2016
- Whelan TJ et al: Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 373(4):307-16, 2015
- Chung J et al: Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol. 55(8):909-16, 2014
- Ganott MA et al: Ultrasound guided core biopsy versus fine needle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. ISRN Oncol. 2014:703160, 2014
- Park SH et al: Imaging findings of variable axillary mass and axillary lymphadenopathy. Ultrasound Med Biol. 40(9):1934-48, 2014
- Abe H et al: Utility of preoperative ultrasound for predicting pN2 or higher stage axillary lymph node involvement in patients with newly diagnosed breast cancer. AJR Am J Roentgenol. 200(3):696-702, 2013
- Cools-Lartigue J et al: Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol. 20(3):819-27, 2013
- Hieken TJ et al: Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Ann Surg Oncol. 20(10):3199-204, 2013
- Lee B et al: The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer. AJR Am J Roentgenol. 200(3):W314-20, 2013
- Park JE et al: Sonographic findings of axillary masses: what can be imaged in this space? J Ultrasound Med. 32(7):1261-70, 2013
- Park YM et al: Imaging-pathologic correlation of diseases in the axilla. AJR Am J Roentgenol. 200(2):W130-42, 2013
- Singh S et al: Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient. BMJ Case Rep. 2013, 2013
- Macaskill EJ et al: Axillary lymph node core biopsy for breast cancer metastases -- how many needle passes are enough? Clin Radiol. 67(5):417-9, 2012
- Riegger C et al: Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol. 53(10):1092-8, 2012
- Solon JG et al: Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases. J Am Coll Surg. 214(1):12-7, 2012
- Giuliano AE et al: Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 305(6):569-75, 2011
- Houssami N et al: Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg. 254(2):243-51, 2011
- Mainiero MB et al: Axillary ultrasound and fine-needle aspiration in the preoperative evaluation of the breast cancer patient: an algorithm based on tumor size and lymph node appearance. AJR Am J Roentgenol. 195(5):1261-7, 2010
- Mainiero MB: Regional lymph node staging in breast cancer: the increasing role of imaging and ultrasound-guided axillary lymph node fine needle aspiration. Radiol Clin North Am. 48(5):989-97, 2010
- Abe H et al: Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy--clinical experience in 100 patients. Radiology. 250(1):41-9, 2009
- Choi YJ et al: High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 18(2):119-22, 2009
- Heusner TA et al: Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients. Eur J Nucl Med Mol Imaging. 36(10):1543-50, 2009
- Kim EY et al: Sonography of axillary masses: what should be considered other than the lymph nodes? J Ultrasound Med. 28(7):923-39, 2009
- Bedi DG et al: Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 191(3):646-52, 2008
- Hinson JL et al: The critical role of axillary ultrasound and aspiration biopsy in the management of breast cancer patients with clinically negative axilla. Ann Surg Oncol. 15(1):250-5, 2008
- Jain A et al: The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol. 15(2):462-71, 2008
- Abe H et al: US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it. Radiographics. 27 Suppl 1:S91-9, 2007
- van Rijk MC et al: Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 13(1):31-5, 2006
- An JK et al: Soft-tissue axillary masses (excluding metastases from breast cancer): sonographic appearances and correlative imaging. J Clin Ultrasound. 33(6):288-97, 2005
- Buchanan CL et al: Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol. 12(12):1045-53, 2005
- Esen G et al: Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol. 15(6):1215-23, 2005
- Lemos S et al: Detection of axillary metastases in breast cancer patients using ultrasound and colour Doppler combined with fine needle aspiration cytology. Eur J Gynaecol Oncol. 26(2):165-6, 2005
- Patel T et al: The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 60(1):64-71, 2005
- Topal U et al: Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma. Eur J Radiol. 56(3):382-5, 2005
- Benoit L et al: Concurrent lymphoma and metastatic breast carcinoma in the axillary, confounding sentinel lymph-node biopsy. Eur J Surg Oncol. 30(4):462-3, 2004
- Brancato B et al: Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging. Radiol Med (Torino). 108(4):345-55, 2004
- Chen C et al: Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy. Clin Breast Cancer. 5(1):72-7, 2004
- Muttarak M et al: Role of mammography in diagnosis of axillary abnormalities in women with normal breast examination. Australas Radiol. 48(3):306-10, 2004
- Said FE et al: Secondary axillary node carcinoma following treatment of Hodgkin's disease. Breast J. 10(2):167-8, 2004
- Wahl RL et al: Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol. 22(2):277-85, 2004
- Muttarak M et al: Mammographic features of tuberculous axillary lymphadenitis. Australas Radiol. 46(3):260-3, 2002
- Lee CH et al: Clinical importance of unilaterally enlarging lymph nodes on otherwise normal mammograms. Radiology. 203(2):329-34, 1997
- Murray ME et al: The clinical importance of axillary lymphadenopathy detected on screening mammography. Clin Radiol. 52(6):458-61, 1997
- Walsh R et al: Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol. 168(1):33-8, 1997
- Dershaw DD et al: Spiculated axillary adenopathy. Radiology. 201(2):439-42, 1996
- Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163:709-711, 1987
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Adenopathy: Morphologically abnormal axillary lymph node(s)
- Axillary lymph node dissection (ALND): Surgical removal of axillary contents (fat and lymph nodes) for staging breast cancer and local disease control
- Sentinel lymph node (SLN): 1st/primary draining node(s); biopsy for staging clinically node-negative breast cancer
- Cross metastases = Axillary nodal metastases from contralateral breast cancer
- Controversial: Stage IV, but may behave as regional disease when occurs as part of recurrence with disrupted lymphatic drainage
- Must exclude ipsilateral primary breast cancer
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Grimm LJ et al: Normal axillary lymph node variability between white and black women on breast MRI. Acad Radiol. 25(3):305-308, 2018
- Le-Petross HT et al: Axillary ultrasound identifies residual nodal disease after chemotherapy: Results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). AJR Am J Roentgenol. 210(3):669-676, 2018
- Farrokh D et al: Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound. Case Rep Obstet Gynecol. 2017:4807013, 2017
- Gajaria PK et al: Fibroadenoma in Axillary Ectopic Breast Tissue Mimicking Lymphadenopathy. J Clin Diagn Res. 11(3):ED01-ED02, 2017
- Gupta A et al: Review of axillary lesions, emphasising some distinctive imaging and pathology findings. J Med Imaging Radiat Oncol. ePub, 2017
- Lim HS et al: Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. J Ultrasound Med. ePub, 2017
- Klang E et al: Association between Enlarged Axillary Lymph Nodes and Silicone Breast Implant Ruptures seen on Magnetic Resonance Imaging. Isr Med Assoc J. 18(12):719-724, 2016
- Whelan TJ et al: Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 373(4):307-16, 2015
- Chung J et al: Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol. 55(8):909-16, 2014
- Ganott MA et al: Ultrasound guided core biopsy versus fine needle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. ISRN Oncol. 2014:703160, 2014
- Park SH et al: Imaging findings of variable axillary mass and axillary lymphadenopathy. Ultrasound Med Biol. 40(9):1934-48, 2014
- Abe H et al: Utility of preoperative ultrasound for predicting pN2 or higher stage axillary lymph node involvement in patients with newly diagnosed breast cancer. AJR Am J Roentgenol. 200(3):696-702, 2013
- Cools-Lartigue J et al: Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol. 20(3):819-27, 2013
- Hieken TJ et al: Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Ann Surg Oncol. 20(10):3199-204, 2013
- Lee B et al: The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer. AJR Am J Roentgenol. 200(3):W314-20, 2013
- Park JE et al: Sonographic findings of axillary masses: what can be imaged in this space? J Ultrasound Med. 32(7):1261-70, 2013
- Park YM et al: Imaging-pathologic correlation of diseases in the axilla. AJR Am J Roentgenol. 200(2):W130-42, 2013
- Singh S et al: Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient. BMJ Case Rep. 2013, 2013
- Macaskill EJ et al: Axillary lymph node core biopsy for breast cancer metastases -- how many needle passes are enough? Clin Radiol. 67(5):417-9, 2012
- Riegger C et al: Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol. 53(10):1092-8, 2012
- Solon JG et al: Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases. J Am Coll Surg. 214(1):12-7, 2012
- Giuliano AE et al: Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 305(6):569-75, 2011
- Houssami N et al: Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg. 254(2):243-51, 2011
- Mainiero MB et al: Axillary ultrasound and fine-needle aspiration in the preoperative evaluation of the breast cancer patient: an algorithm based on tumor size and lymph node appearance. AJR Am J Roentgenol. 195(5):1261-7, 2010
- Mainiero MB: Regional lymph node staging in breast cancer: the increasing role of imaging and ultrasound-guided axillary lymph node fine needle aspiration. Radiol Clin North Am. 48(5):989-97, 2010
- Abe H et al: Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy--clinical experience in 100 patients. Radiology. 250(1):41-9, 2009
- Choi YJ et al: High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 18(2):119-22, 2009
- Heusner TA et al: Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients. Eur J Nucl Med Mol Imaging. 36(10):1543-50, 2009
- Kim EY et al: Sonography of axillary masses: what should be considered other than the lymph nodes? J Ultrasound Med. 28(7):923-39, 2009
- Bedi DG et al: Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 191(3):646-52, 2008
- Hinson JL et al: The critical role of axillary ultrasound and aspiration biopsy in the management of breast cancer patients with clinically negative axilla. Ann Surg Oncol. 15(1):250-5, 2008
- Jain A et al: The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol. 15(2):462-71, 2008
- Abe H et al: US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it. Radiographics. 27 Suppl 1:S91-9, 2007
- van Rijk MC et al: Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 13(1):31-5, 2006
- An JK et al: Soft-tissue axillary masses (excluding metastases from breast cancer): sonographic appearances and correlative imaging. J Clin Ultrasound. 33(6):288-97, 2005
- Buchanan CL et al: Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol. 12(12):1045-53, 2005
- Esen G et al: Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol. 15(6):1215-23, 2005
- Lemos S et al: Detection of axillary metastases in breast cancer patients using ultrasound and colour Doppler combined with fine needle aspiration cytology. Eur J Gynaecol Oncol. 26(2):165-6, 2005
- Patel T et al: The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 60(1):64-71, 2005
- Topal U et al: Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma. Eur J Radiol. 56(3):382-5, 2005
- Benoit L et al: Concurrent lymphoma and metastatic breast carcinoma in the axillary, confounding sentinel lymph-node biopsy. Eur J Surg Oncol. 30(4):462-3, 2004
- Brancato B et al: Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging. Radiol Med (Torino). 108(4):345-55, 2004
- Chen C et al: Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy. Clin Breast Cancer. 5(1):72-7, 2004
- Muttarak M et al: Role of mammography in diagnosis of axillary abnormalities in women with normal breast examination. Australas Radiol. 48(3):306-10, 2004
- Said FE et al: Secondary axillary node carcinoma following treatment of Hodgkin's disease. Breast J. 10(2):167-8, 2004
- Wahl RL et al: Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol. 22(2):277-85, 2004
- Muttarak M et al: Mammographic features of tuberculous axillary lymphadenitis. Australas Radiol. 46(3):260-3, 2002
- Lee CH et al: Clinical importance of unilaterally enlarging lymph nodes on otherwise normal mammograms. Radiology. 203(2):329-34, 1997
- Murray ME et al: The clinical importance of axillary lymphadenopathy detected on screening mammography. Clin Radiol. 52(6):458-61, 1997
- Walsh R et al: Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol. 168(1):33-8, 1997
- Dershaw DD et al: Spiculated axillary adenopathy. Radiology. 201(2):439-42, 1996
- Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163:709-711, 1987
