The role of computed tomography in the investigation of recurrent axillary disease in patients with carcinoma of the breast.

Carcinoma of the breast commonly recurs in the axilla. A nodal mass may be palpable and computed tomography (CT) is frequently requested in order to differentiate recurrent tumour from the longer term effects of surgery and radiotherapy. We have reviewed the CT scans of 35 such patients referred consecutively to our CT unit. CT only detected the presence of recurrent tumour in one patient in whom a mass could not be palpated. This patient had a previously irradiated 'wooden' axilla making clinical examination impossible. CT failed to diagnose recurrence in two patients; one with disease in normal sized nodes and the other with axillary vein thrombosis. We conclude that CT of the axilla only appears to be of value when the axilla is impossible to palpate due to previous treatment. The key to the diagnosis of axillary tumour recurrence is careful palpation supplemented by aspiration cytology of any mass. When no mass is evident on clinical examination, CT is unlikely to demonstrate disease.