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A practical approach to imaging the axilla.

Dialani V, James DF, Slanetz PJ - Insights Imaging (2014)

Bottom Line: An awareness of the axillary anatomy is essential in order to generate an accurate differential diagnosis and guide patient management.The purpose of this article is to review the indications for axillary imaging, discuss the logistics of the scanning technique and percutaneous interventions, and present the imaging findings and management of a variety of breast diseases involving the axilla.Teaching points • Knowledge of normal axillary anatomy aids in determining the aetiology of an axillary mass. • The differential diagnosis of an axillary mass is broad and can be subdivided by the location of the lesion. • Imaging evaluation of the axilla usually entails diagnostic mammography and targeted ultrasound. • FNA or core needle biopsies are safe and accurate methods for diagnosis and guiding management.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT
Imaging of the axilla typically occurs when patients present with axillary symptoms or newly diagnosed breast cancer. An awareness of the axillary anatomy is essential in order to generate an accurate differential diagnosis and guide patient management. The purpose of this article is to review the indications for axillary imaging, discuss the logistics of the scanning technique and percutaneous interventions, and present the imaging findings and management of a variety of breast diseases involving the axilla. Teaching points • Knowledge of normal axillary anatomy aids in determining the aetiology of an axillary mass. • The differential diagnosis of an axillary mass is broad and can be subdivided by the location of the lesion. • Imaging evaluation of the axilla usually entails diagnostic mammography and targeted ultrasound. • FNA or core needle biopsies are safe and accurate methods for diagnosis and guiding management.

No MeSH data available.


Related in: MedlinePlus

A 47-year-old female with a palpable left breast lump. a Left MLO view with magnified image of the left axilla demonstrates a 1.4 × 1-cm lymph node with eccentric cortical thickening and cortical calcifications. b Transverse image of left axillary lymph node confirms echogenic foci within the thickened cortex suspicious for malignancy. FNA was performed with aspirates sent for routine cytology and flow cytometry. Final diagnosis: metastatic carcinoma
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Fig7: A 47-year-old female with a palpable left breast lump. a Left MLO view with magnified image of the left axilla demonstrates a 1.4 × 1-cm lymph node with eccentric cortical thickening and cortical calcifications. b Transverse image of left axillary lymph node confirms echogenic foci within the thickened cortex suspicious for malignancy. FNA was performed with aspirates sent for routine cytology and flow cytometry. Final diagnosis: metastatic carcinoma

Mentions: A focal cortical bulge (Fig. 7) or thickening is considered the earliest detectable morphologic change in the presence of metastasis, but this criterion is difficult to apply and has a low positive predictive value because it is non-specific. This finding is therefore considered indeterminate. A true abnormal cortical bulge is seen as focal thickening of the cortex that does not follow the margin of the echogenic hilum and should be distinctly hypoechoic, and this sign is more accurate if associated with another finding such as the presence of cortical in addition to hilar blood flow. Diffuse cortical thickening can also be seen with metastasis, but this finding is even more non-specific, more often being associated with a reactive node. Eccentric cortical thickening is more suspicious than diffuse thickening, but both are non-specific and concerning enough to warrant intervention in most cases (Fig. 8). Findings seen in cases with more advanced nodal involvement, such as effacement of the fatty hilum or a rounded hypoechoic mass, have a higher positive predictive value in patients with invasive breast cancer. Replacement of the entire node or a portion of the node by an ill-defined mass is highly suspicious for malignant involvement. Occasionally, nodal microcalcifications can be seen on imaging (Fig. 7).Fig. 7


A practical approach to imaging the axilla.

Dialani V, James DF, Slanetz PJ - Insights Imaging (2014)

A 47-year-old female with a palpable left breast lump. a Left MLO view with magnified image of the left axilla demonstrates a 1.4 × 1-cm lymph node with eccentric cortical thickening and cortical calcifications. b Transverse image of left axillary lymph node confirms echogenic foci within the thickened cortex suspicious for malignancy. FNA was performed with aspirates sent for routine cytology and flow cytometry. Final diagnosis: metastatic carcinoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4376818&req=5

Fig7: A 47-year-old female with a palpable left breast lump. a Left MLO view with magnified image of the left axilla demonstrates a 1.4 × 1-cm lymph node with eccentric cortical thickening and cortical calcifications. b Transverse image of left axillary lymph node confirms echogenic foci within the thickened cortex suspicious for malignancy. FNA was performed with aspirates sent for routine cytology and flow cytometry. Final diagnosis: metastatic carcinoma
Mentions: A focal cortical bulge (Fig. 7) or thickening is considered the earliest detectable morphologic change in the presence of metastasis, but this criterion is difficult to apply and has a low positive predictive value because it is non-specific. This finding is therefore considered indeterminate. A true abnormal cortical bulge is seen as focal thickening of the cortex that does not follow the margin of the echogenic hilum and should be distinctly hypoechoic, and this sign is more accurate if associated with another finding such as the presence of cortical in addition to hilar blood flow. Diffuse cortical thickening can also be seen with metastasis, but this finding is even more non-specific, more often being associated with a reactive node. Eccentric cortical thickening is more suspicious than diffuse thickening, but both are non-specific and concerning enough to warrant intervention in most cases (Fig. 8). Findings seen in cases with more advanced nodal involvement, such as effacement of the fatty hilum or a rounded hypoechoic mass, have a higher positive predictive value in patients with invasive breast cancer. Replacement of the entire node or a portion of the node by an ill-defined mass is highly suspicious for malignant involvement. Occasionally, nodal microcalcifications can be seen on imaging (Fig. 7).Fig. 7

Bottom Line: An awareness of the axillary anatomy is essential in order to generate an accurate differential diagnosis and guide patient management.The purpose of this article is to review the indications for axillary imaging, discuss the logistics of the scanning technique and percutaneous interventions, and present the imaging findings and management of a variety of breast diseases involving the axilla.Teaching points • Knowledge of normal axillary anatomy aids in determining the aetiology of an axillary mass. • The differential diagnosis of an axillary mass is broad and can be subdivided by the location of the lesion. • Imaging evaluation of the axilla usually entails diagnostic mammography and targeted ultrasound. • FNA or core needle biopsies are safe and accurate methods for diagnosis and guiding management.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT
Imaging of the axilla typically occurs when patients present with axillary symptoms or newly diagnosed breast cancer. An awareness of the axillary anatomy is essential in order to generate an accurate differential diagnosis and guide patient management. The purpose of this article is to review the indications for axillary imaging, discuss the logistics of the scanning technique and percutaneous interventions, and present the imaging findings and management of a variety of breast diseases involving the axilla. Teaching points • Knowledge of normal axillary anatomy aids in determining the aetiology of an axillary mass. • The differential diagnosis of an axillary mass is broad and can be subdivided by the location of the lesion. • Imaging evaluation of the axilla usually entails diagnostic mammography and targeted ultrasound. • FNA or core needle biopsies are safe and accurate methods for diagnosis and guiding management.

No MeSH data available.


Related in: MedlinePlus