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The role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer.

Nieciecki M, Dobruch-Sobczak K, Wareluk P, Gumińska A, Białek E, Cacko M, Królicki L - J Ultrason (2016)

Bottom Line: The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works.Furthermore, different lymphoscintigraphy protocols have been compared in the literature.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging, Mazovian Bródno Hospital, Warsaw, Poland.

ABSTRACT
Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel node biopsy procedures and breast-conserving surgeries has increased. Intraoperative sentinel lymph node biopsy preceded by lymphoscintigraphy is used in breast cancer patients with no clinical signs of lymph node metastasis. Due to the limited sensitivity and specificity of physical examination in detecting metastatic lesions, developing an appropriate diagnostic algorithm for the preoperative assessment of axillary lymph nodes seems to be a challenge. The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works. Furthermore, different lymphoscintigraphy protocols have been compared in the literature. The usefulness of novel radiopharmaceuticals as well as the methods of image acquisition in sentinel lymph node diagnostics have also been assessed. The aim of this article is to present, basing on current guidelines, literature data as well as our own experience, the diagnostic possibilities of axillary lymph node ultrasound in patient qualification for an appropriate treatment as well as the role of lymphoscintigraphy in sentinel lymph node biopsy.

No MeSH data available.


Related in: MedlinePlus

B-mode ultrasound image of axillary lymph node suspected of breast cancer metastasis. Thickened lymph node cortex as well as its reduced echogenicity and hilar blurring are noticeable
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Figure 0003: B-mode ultrasound image of axillary lymph node suspected of breast cancer metastasis. Thickened lymph node cortex as well as its reduced echogenicity and hilar blurring are noticeable

Mentions: It was observed that breast cancer metastases initially occur in the subcapsular or cortical sinuses, leading to cortical thickening(14). Therefore, metastatic lymph nodes can often show eccentric thickening of the cortex. Fine needle aspiration biopsy (FNAB) should be performed in these thickened sites(11). In some patients, the metastatic thickening of the cortex may be very severe and cause obliteration of the lymph node hilum – blurring or absence of the hilum may be seen on ultrasound. Although highly specific for metastatic lesions, it occurs in advanced stages of cancer(12, 13). A similar mechanism underlies the rounding of the node, i.e. long/short axis disproportion, which is also a sign of metastatic lymph nodes. The presence of tumor cells can also decrease cortical echogenicity and result in blurred outlines of the capsule. In some patients, calcifications may occur in the involved lymph nodes, especially if they were present in the primary malignancy(11, 15) (Fig. 3).


The role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer.

Nieciecki M, Dobruch-Sobczak K, Wareluk P, Gumińska A, Białek E, Cacko M, Królicki L - J Ultrason (2016)

B-mode ultrasound image of axillary lymph node suspected of breast cancer metastasis. Thickened lymph node cortex as well as its reduced echogenicity and hilar blurring are noticeable
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834366&req=5

Figure 0003: B-mode ultrasound image of axillary lymph node suspected of breast cancer metastasis. Thickened lymph node cortex as well as its reduced echogenicity and hilar blurring are noticeable
Mentions: It was observed that breast cancer metastases initially occur in the subcapsular or cortical sinuses, leading to cortical thickening(14). Therefore, metastatic lymph nodes can often show eccentric thickening of the cortex. Fine needle aspiration biopsy (FNAB) should be performed in these thickened sites(11). In some patients, the metastatic thickening of the cortex may be very severe and cause obliteration of the lymph node hilum – blurring or absence of the hilum may be seen on ultrasound. Although highly specific for metastatic lesions, it occurs in advanced stages of cancer(12, 13). A similar mechanism underlies the rounding of the node, i.e. long/short axis disproportion, which is also a sign of metastatic lymph nodes. The presence of tumor cells can also decrease cortical echogenicity and result in blurred outlines of the capsule. In some patients, calcifications may occur in the involved lymph nodes, especially if they were present in the primary malignancy(11, 15) (Fig. 3).

Bottom Line: The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works.Furthermore, different lymphoscintigraphy protocols have been compared in the literature.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging, Mazovian Bródno Hospital, Warsaw, Poland.

ABSTRACT
Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel node biopsy procedures and breast-conserving surgeries has increased. Intraoperative sentinel lymph node biopsy preceded by lymphoscintigraphy is used in breast cancer patients with no clinical signs of lymph node metastasis. Due to the limited sensitivity and specificity of physical examination in detecting metastatic lesions, developing an appropriate diagnostic algorithm for the preoperative assessment of axillary lymph nodes seems to be a challenge. The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works. Furthermore, different lymphoscintigraphy protocols have been compared in the literature. The usefulness of novel radiopharmaceuticals as well as the methods of image acquisition in sentinel lymph node diagnostics have also been assessed. The aim of this article is to present, basing on current guidelines, literature data as well as our own experience, the diagnostic possibilities of axillary lymph node ultrasound in patient qualification for an appropriate treatment as well as the role of lymphoscintigraphy in sentinel lymph node biopsy.

No MeSH data available.


Related in: MedlinePlus