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Axillary Adenopathy
Haydee Ojeda-Fournier, MD; Wei Tse Yang, MBBS; Wendie A. Berg, MD, PhD
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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

                                                1. Grimm LJ et al: Normal axillary lymph node variability between white and black women on breast MRI. Acad Radiol. 25(3):305-308, 2018
                                                2. 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
                                                3. Farrokh D et al: Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound. Case Rep Obstet Gynecol. 2017:4807013, 2017
                                                4. Gajaria PK et al: Fibroadenoma in Axillary Ectopic Breast Tissue Mimicking Lymphadenopathy. J Clin Diagn Res. 11(3):ED01-ED02, 2017
                                                5. Gupta A et al: Review of axillary lesions, emphasising some distinctive imaging and pathology findings. J Med Imaging Radiat Oncol. ePub, 2017
                                                6. Lim HS et al: Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. J Ultrasound Med. ePub, 2017
                                                7. 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
                                                8. Whelan TJ et al: Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 373(4):307-16, 2015
                                                9. Chung J et al: Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol. 55(8):909-16, 2014
                                                10. 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
                                                11. Park SH et al: Imaging findings of variable axillary mass and axillary lymphadenopathy. Ultrasound Med Biol. 40(9):1934-48, 2014
                                                12. 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
                                                13. 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
                                                14. 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
                                                15. 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
                                                16. Park JE et al: Sonographic findings of axillary masses: what can be imaged in this space? J Ultrasound Med. 32(7):1261-70, 2013
                                                17. Park YM et al: Imaging-pathologic correlation of diseases in the axilla. AJR Am J Roentgenol. 200(2):W130-42, 2013
                                                18. 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
                                                19. 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
                                                20. 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
                                                21. 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
                                                22. 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
                                                23. 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
                                                24. 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
                                                25. 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
                                                26. 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
                                                27. Choi YJ et al: High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 18(2):119-22, 2009
                                                28. 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
                                                29. 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
                                                30. 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
                                                31. 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
                                                32. 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
                                                33. 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
                                                34. 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
                                                35. 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
                                                36. 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
                                                37. 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
                                                38. 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
                                                39. Patel T et al: The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 60(1):64-71, 2005
                                                40. 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
                                                41. 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
                                                42. 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
                                                43. 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
                                                44. 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
                                                45. Said FE et al: Secondary axillary node carcinoma following treatment of Hodgkin's disease. Breast J. 10(2):167-8, 2004
                                                46. 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
                                                47. Muttarak M et al: Mammographic features of tuberculous axillary lymphadenitis. Australas Radiol. 46(3):260-3, 2002
                                                48. Lee CH et al: Clinical importance of unilaterally enlarging lymph nodes on otherwise normal mammograms. Radiology. 203(2):329-34, 1997
                                                49. Murray ME et al: The clinical importance of axillary lymphadenopathy detected on screening mammography. Clin Radiol. 52(6):458-61, 1997
                                                50. Walsh R et al: Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol. 168(1):33-8, 1997
                                                51. Dershaw DD et al: Spiculated axillary adenopathy. Radiology. 201(2):439-42, 1996
                                                52. Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163:709-711, 1987
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                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

                                                                                              1. Grimm LJ et al: Normal axillary lymph node variability between white and black women on breast MRI. Acad Radiol. 25(3):305-308, 2018
                                                                                              2. 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
                                                                                              3. Farrokh D et al: Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound. Case Rep Obstet Gynecol. 2017:4807013, 2017
                                                                                              4. Gajaria PK et al: Fibroadenoma in Axillary Ectopic Breast Tissue Mimicking Lymphadenopathy. J Clin Diagn Res. 11(3):ED01-ED02, 2017
                                                                                              5. Gupta A et al: Review of axillary lesions, emphasising some distinctive imaging and pathology findings. J Med Imaging Radiat Oncol. ePub, 2017
                                                                                              6. Lim HS et al: Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. J Ultrasound Med. ePub, 2017
                                                                                              7. 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
                                                                                              8. Whelan TJ et al: Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 373(4):307-16, 2015
                                                                                              9. Chung J et al: Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol. 55(8):909-16, 2014
                                                                                              10. 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
                                                                                              11. Park SH et al: Imaging findings of variable axillary mass and axillary lymphadenopathy. Ultrasound Med Biol. 40(9):1934-48, 2014
                                                                                              12. 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
                                                                                              13. 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
                                                                                              14. 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
                                                                                              15. 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
                                                                                              16. Park JE et al: Sonographic findings of axillary masses: what can be imaged in this space? J Ultrasound Med. 32(7):1261-70, 2013
                                                                                              17. Park YM et al: Imaging-pathologic correlation of diseases in the axilla. AJR Am J Roentgenol. 200(2):W130-42, 2013
                                                                                              18. 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
                                                                                              19. 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
                                                                                              20. 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
                                                                                              21. 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
                                                                                              22. 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
                                                                                              23. 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
                                                                                              24. 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
                                                                                              25. 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
                                                                                              26. 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
                                                                                              27. Choi YJ et al: High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 18(2):119-22, 2009
                                                                                              28. 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
                                                                                              29. 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
                                                                                              30. 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
                                                                                              31. 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
                                                                                              32. 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
                                                                                              33. 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
                                                                                              34. 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
                                                                                              35. 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
                                                                                              36. 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
                                                                                              37. 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
                                                                                              38. 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
                                                                                              39. Patel T et al: The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 60(1):64-71, 2005
                                                                                              40. 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
                                                                                              41. 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
                                                                                              42. 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
                                                                                              43. 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
                                                                                              44. 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
                                                                                              45. Said FE et al: Secondary axillary node carcinoma following treatment of Hodgkin's disease. Breast J. 10(2):167-8, 2004
                                                                                              46. 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
                                                                                              47. Muttarak M et al: Mammographic features of tuberculous axillary lymphadenitis. Australas Radiol. 46(3):260-3, 2002
                                                                                              48. Lee CH et al: Clinical importance of unilaterally enlarging lymph nodes on otherwise normal mammograms. Radiology. 203(2):329-34, 1997
                                                                                              49. Murray ME et al: The clinical importance of axillary lymphadenopathy detected on screening mammography. Clin Radiol. 52(6):458-61, 1997
                                                                                              50. Walsh R et al: Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol. 168(1):33-8, 1997
                                                                                              51. Dershaw DD et al: Spiculated axillary adenopathy. Radiology. 201(2):439-42, 1996
                                                                                              52. Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163:709-711, 1987