Ultraschall Med 2016; 37 - SL16_1
DOI: 10.1055/s-0036-1587786

Axillary Ultrasound (AUS) Excludes Clinical Lymph Node Disease In Early Breast Cancer

A Düran 1
  • 1Vivantes Humboldt Krankenhaus Berlin, Department Obstetrics Gynecology, Berlin, Germany

Background: It have been observed, that the caudal Axilla on the border to pectoralis muscle is predicive for the sentinel node and the sono-morphology of lymph nodes has been the subject of multiple publications, usually dealing with malignant Melanoma. In the context of Sentinel lymph node biopsy (SLNB) in breast cancer patients, the following study examines the feasibility of the sonographic differentiation of the Sentinel lymph node (SLN) from neighboring non-SLNs and whether Axillary Ultrasound (AUS) is a useful addition or alternative to current methods of “lymphatic mapping”

Methods:During a prospective study performed from 1/2003 to 9/2005 including 404 breast cancer patients (Tis-T4), the SLNB was performed using Patent blue+/- 99Tc-Nanocoll. In addition to and independent of this method, the axilla was sonographically examined for “reactive” lymph nodes n = 180 pt. (Siemens Elegra 7.5 MHz). The “Reactivity” of the nodes was quantified using an index, which allowed the comparison of adjacent nodes. The most “reactive” lymph node in the caudal axilla was identified as the Sentinel node.

Results: In 180 Patients the SLN was localized using the standard methods as well as (AUS). The was no difference in detection rate for tumor free nodes (SLN -) and using the standard methods. However with metastasized nodes (SLN+) the SUN method provided superior detection (99.1%) and the false-negative-rate could be reduced from 10.7% to 1.3%. This was attributed to the embolization of lymph vessels afferent to the metastasized (SLN+) node causing a bypass of the “lymphatic mapping” and inhibiting detection.

Conclusions: AUS – Method is comparable to “lymphatic mapping” in tumor free nodes (SLN -). With metastasized nodes (SLN+) AUS is superior to the standard methods in Sensitivity und Specificity (80%) and the false-negative-rate can be reduced. Systematic Axilla sonography is an effective method for the SLN-Localisation, and offers an excellent method for quality control during SLNB.