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
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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