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Breast Imaging

E3135. The Atypical Malignant Axillary Lymph Node in Patients With Breast Cancer

Arribas E,  Huang M,  Middleton L,  Rauch G,  Santiago L. University of Texas MD Anderson Cancer Center, Houston, TX

Address correspondence to E. Arribas (

Background Information: The presence of axillary lymph node metastasis is a main prognostic factor that impacts overall survival in breast cancer patients. Determining the presence and extent of regional nodal metastasis at the time of diagnosis aids in surgical and chemotherapy treatment planning. Ultrasound assessment of the regional nodal basins is routinely performed at some institutions in the staging evaluation of patients with breast cancer prior to treatment. Ultrasound allows for morphologic evaluation of axillary lymph nodes, and sonographic features of suspicious lymph nodes have been previously reported. Lymph nodes with suspicious appearance at imaging may undergo ultrasound-guided needle biopsy to confirm the presence of metastatic disease before treatment. The purpose of this exhibit is to review and discuss the atypical sonographic features of biopsy-proven metastatic axillary lymph nodes in breast cancer.

Educational Goals/Teaching Points: We will review normal lymph node morphology on ultrasound and sonographic features of metastatic breast carcinoma in axillary lymph nodes. We will describe atypical sonographic features of breast cancer metastatic lymph nodes with correlation to primary breast cancer histology. Additionally, we will review challenges in the identification and biopsy of metastatic axillary lymph nodes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We will review ultrasound features of normal axillary lymph nodes, typical ultrasound features of breast cancer metastatic lymph nodes, and atypical ultrasound findings of breast cancer metastatic lymph nodes with pathology correlation.

Conclusion: Knowledge of the atypical sonographic features of metastatic axillary lymph nodes in breast cancer will allow for identification of metastatic disease prior to treatment with concurrent ultrasound-guided biopsy for appropriate treatment planning, thus impacting outcome.