Department of Obstetrics and Gynecology, Hospital Thun STS AG, Thun, Switzerland.
Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):88-91. doi: 10.1016/j.ejogrb.2010.02.011. Epub 2010 Mar 1.
The aim of this study was to evaluate the pathological findings and the method of tissue harvesting in those patients who have both suspicious axillary lymph nodes and normal imaging of the breast.
From January 2005 to June 2008 all female patients who underwent opportunistic screening mammography and ultrasound examination of the breast and the axilla, and who were found to have suspicious axillary lymph nodes seen on ultrasound examination, were retrospectively analysed. Tissue harvesting was done by fine needle aspiration, core needle biopsy, or open biopsy.
Out of approximately 7500 screened patients, 51 were found to have suspicious axillary lymph nodes on ultrasound with unremarkable breast ultrasound and mammography. Histopathology and/or cytology of these lymph nodes showed 33 benign and 18 malignant results. Of the malignant results only 1 case was an occult invasive lobular breast carcinoma detected afterwards on breast magnetic resonance imaging. Eleven cases were non-Hodgkin lymphomas, 4 were malignant melanomas, and 2 were metastases from the lower genital tract. Diffuse cortical thickening and complete loss of echo texture were the only features on ultrasound predicting malignancy. Palpation and mean size of the evaluated lymph nodes had no predictive value for malignancy. In the 33 cases of non-malignant pathology 9 patients showed patterns of specific infectious disease, including 4 patients with tuberculosis.
Suspicious lymph nodes of the axilla seen on ultrasound rarely indicate occult breast cancer but show a variety of other malignancies and generalised infectious disease requiring further treatment. Fine needle aspiration and/or core needle biopsy are both sufficient methods for clarification in the majority of cases.
本研究旨在评估同时存在可疑腋窝淋巴结和乳腺正常影像学表现的患者的病理发现和组织采集方法。
本研究回顾性分析了 2005 年 1 月至 2008 年 6 月期间所有接受机会性乳腺 X 线摄影和乳腺及腋窝超声检查且超声检查发现可疑腋窝淋巴结的女性患者。组织采集方法包括细针抽吸、核心针活检或开放活检。
在大约 7500 名筛查患者中，有 51 名患者的超声检查发现可疑腋窝淋巴结，乳腺超声和 X 线摄影未见异常。这些淋巴结的组织病理学和/或细胞学检查显示 33 例为良性，18 例为恶性。在恶性结果中，仅 1 例后来在乳腺磁共振成像上发现隐匿性浸润性小叶乳腺癌。11 例为非霍奇金淋巴瘤，4 例为恶性黑色素瘤，2 例为来自下生殖道的转移癌。超声检查中皮质弥漫性增厚和回声纹理完全丧失是唯一提示恶性的特征。触诊和评估淋巴结的平均大小对恶性肿瘤没有预测价值。在 33 例非恶性病理中，有 9 例患者表现出特定传染病的模式，包括 4 例结核病。
超声检查发现可疑腋窝淋巴结很少提示隐匿性乳腺癌，但表现为多种其他恶性肿瘤和全身性传染病，需要进一步治疗。在大多数情况下，细针抽吸和/或核心针活检都是明确诊断的充分方法。
