5/10/17 1 Radiologic Management of the Axilla Janice S. Sung, MD Breast Imaging Section Department of Radiology Memorial Sloan-Kettering Cancer Center New York, NY Outline • Normal anatomy • Normal vs abnormal nodes • Differential diagnosis • Management in CA patient Lymph Node Levels • Level I – Lateral to pectoralis minor • Level II – Behind pectoralis minor • Level III – Medial to pectoralis minor Normal vs Abnormal Nodes Normal LN on Mammography • Seen on >50% of screening MG – Location: axilla, axillary tail, UOQ – Shape: oval, reniform – Morphology: circumscribed, fatty hilum
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5/10/17
1
Radiologic Management of the Axilla
Janice S. Sung, MD Breast Imaging Section
Department of Radiology Memorial Sloan-Kettering Cancer Center
New York, NY
Outline
• Normal anatomy • Normal vs abnormal nodes • Differential diagnosis • Management in CA patient
Lymph Node Levels
• Level I – Lateral to pectoralis minor
• Level II – Behind pectoralis minor
• Level III – Medial to pectoralis minor
Normal vs Abnormal Nodes
Normal LN on Mammography
• Seen on >50% of screening MG – Location: axilla, axillary tail, UOQ – Shape: oval, reniform – Morphology: circumscribed, fatty hilum
5/10/17
2
Normal LN on US
Normal/Benign
Abnormal
Shape Oval, lobulated Round
Cortex Uniformly ≤ 3 mm
> 3mm, focal thickening
Echogenic fatty hilum
Present Absent or displaced
Vascularity Single hilar vessel
Peripheral vascularization
Echogenicity Homogeneous Heterogeneous, hypoechoic Net J Radiographics
• Women with negative axillary US and sentinel node with > 2 nodes recovered – False neg rate: 9.8%
• Conclusion: Axillary US should be done after NAC – Full ax dissection may not be necessary in women
who have a negative post NAC US and at least 2 negative sentinel nodes
Boughey et al J Clin Onc 2015;33
Clipping Axillary Nodes Prior to NAC
• 191 patients with positive axillary node, clip placed at time of biopsy
• Targeted axillary dissection of clipped node and sentinel node vs ALND – Clipped node not among sentinel node in 23% – SLN negative and mets in clipped node in 6 women