Annals of SBV

Register      Login

VOLUME 12 , ISSUE 2 ( July-December, 2023 ) > List of Articles


Ultrasound Morphology of Axillary Lymph Nodes as a Non-invasive Alternative to Detect Metastasis in Early Breast Cancer

Sandeep Reuben Manohar, Tirou Aroult

Keywords : Axillary lymph node, Axillary ultrasound, Sentinel lymph node biopsy

Citation Information : Manohar SR, Aroult T. Ultrasound Morphology of Axillary Lymph Nodes as a Non-invasive Alternative to Detect Metastasis in Early Breast Cancer. 2023; 12 (2):33-37.

DOI: 10.5005/jp-journals-10085-9128

License: CC BY-NC 4.0

Published Online: 02-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


The axillary lymph node status is the most important prognostic factor in early stage breast cancer. A sentinel lymph node biopsy determines whether axillary node dissection is necessary. The use of the operating room and the administration of radioisotopes are also costs associated with this operation. As a result, patients with nodal metastases that could lead to axillary dissection should be identified before surgery. Axillary ultrasound is widely being used to determine nodal status prior to surgery. It has been shown to be a receptive and accurate modality for detecting nodal metastases. When combined with fine-needle aspiration, this modality's precision is greatly improved. This article discusses preoperative axillary ultrasound (PAUS) in early and locally advanced breast cancer patients with and without fine-needle aspiration biopsy. Based on this analysis, we estimate the proportion of patients who would be able to escape a sentinel lymph node biopsy, as well as the cost benefit of axillary ultrasound.

  1. Maxwell F, Mellon CDM, Bricout M, Cauderlier E, Chapelier M, Albiter M, et al. Diagnostic strategy for the assessment of axillary lymph node status in breast cancer. Diagn Interv Imaging 2015;96:1089–1101. DOI: 10.1016/j.diii.2015.07.007.
  2. Stachs A, Göde K, Hartmann S, Stengel B, Nierling U, Dieterich M, et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer—Size of metastases as limiting factor. Springerplus 2013;2:350. DOI: 10.1186/2193-1801-2-350.
  3. Dihge L. Predictors of lymph node metastasis in primary breast cancer risk models for tailored axillary management. Ph.D. Thesis, Lund University, Lund, Sweden, 2018.
  4. Zahoor S, Haji A, Battoo A, Qurieshi M, Mir W, Shah M. Sentinel lymph node biopsy in breast cancer: A clinical review and update. J Breast Cancer 2017;20(3):217–227. DOI: 10.4048/jbc.2017.20.3.217.
  5. Barco I, Chabrera C, García-Fernández A, Fraile M, González S, Canales L, et al. Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients. Clin Transl Oncol 2017;19(6):704–710. DOI: 10.1007/s12094-016-1589-7.
  6. Avisar E, Ozmen T. Management of the positive axilla in 2017. Breast Cancer Res Treat 2017;163(3):413–415. DOI: 10.1007/s10549-017-4227-3.
  7. Jozsa F, Ahmed M, Baker R, Douek M. Is sentinel node biopsy necessary in the radiologically negative axilla in breast cancer? Breast Cancer Res Treat 2019;177(1):1–4. DOI: 10.1007/s10549-019-05299-5.
  8. Gipponi M, Fregatti P, Garlaschi A, Murelli F, Margarino C, Depaoli F, et al. Axillary ultrasound and fine-needle aspiration cytology in the preoperative staging of axillary node metastasis in breast cancer patients. Breast 2016;30:146–150. DOI: 10.1016/j.breast.2016.09.009.
  9. NCT02167490. Sentinel Node vs. Observation after Axillary Ultra-souND. Available from:
  10. Jackson RS, Mylander C, Rosman M, Andrade R, Sawyer K, Sanders P, et al. Normal axillary ultrasound excludes heavy nodal disease burden in patients with breast cancer. Ann Surg Oncol 2015;22:3289–3295. DOI: 10.1245/s10434-015-4717-7.
  11. Artmoniene D. Breast cancer: The accuracy of the Paus in detecting pN2 and factors that lead to the true and false-negative results. Biomed J Sci Tech Res 2019;12:1–9. DOI: 10.26717/BJSTR.2019.12.002301.
  12. Gentilini O, Botteri E, Dadda P, Sangalli C, Boccardo C, Peradze N, et al. Physical function of the upper limb after breast cancer surgery. Results from the SOUND (Sentinel node vs. Observation after axillary Ultra-souND) trial. Eur J Surg Oncol 2016;42:685–689. DOI: 10.1016/j.ejso.2016.01.020.
  13. Reimer T, Stachs A, Nekljudova V, Loibl S, Hartmann S, Wolter K, et al. Restricted axillary staging in clinically and sonographically node-negative early invasive breast cancer (C/IT1-2) in the context of breast conserving therapy: First results following commencement of the intergroup-sentinel-mamma (INSEMA) trial. Geburtshilfe Frauenheilkd 2017;77(2):149–157. DOI: 10.1055/s-0042-122853.
  14. Lernevall A. Imaging of axillary lymph nodes. Acta Oncol 2000;39(3):277–281. DOI: 10.1080/028418600750013014.
  15. Jemec GB, Gniadecka M, Ulrich J. Ultrasound in dermatology. Part I. High frequency ultrasound. Eur J Dermatol 2000;10(6):492–497. PMID: 10980479.
  16. Bruneton JN, Caramella E, Hery M, Aubanel D, Manzino JJ, Picard JL. Axillary lymph node metastases in breast cancer: Preoperative detection with US. Radiology 1986;158(2):325–326. DOI: 10.1148/radiology.158.2.3510440.
  17. Vaidya JS, Vyas JJ, Thakur MH, Khandelwal KC, Mittra I. Role of ultrasonography to detect axillary node involvement in operable breast cancer. Eur J Surg Oncol 1996;22(2):140–143. DOI: 10.1016/s0748-7983(96)90593-4.
  18. Bonnema J, van Geel AN, van Ooijen B, Mali SP, Tjiam SL, Henzen-Logmans SC, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: New diagnostic method. World J Surg 1997;21(3):270–274. DOI: 10.1007/s002689900227.
  19. Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kroger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 2003;39(8):1068–1073. DOI: 10.1016/s0959-8049(02)00748-7.
  20. Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med 1996;15(3):241–246. DOI: 10.7863/jum.1996.15.3.241.
  21. Bedrosian I, Bedi D, Kuerer HM, Fornage BD, Harker L, Ross MI, et al. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 2003;10(9):1025–1030. DOI: 10.1245/aso.2003.12.017.
  22. van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2006;13(1):31–35. DOI: 10.1245/ASO.2005.01.024.
  23. Cowher MS, Erb KM, Poller W, Julian TB. Correlation of the use of axillary ultrasound and lymph node needle biopsy with surgical lymph node pathology in patients with invasive breast cancer. Am J Surg 2008;196(5):756–759. DOI: 10.1016/j.amjsurg.2007.11.015.
  24. Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: A systematic review. AJR Am J Roentgenol 2006;186(5):1342–1348. DOI: 10.2214/AJR.05.0936.
  25. Verbanck J, Vandewiele I, De Winter H, Tytgat J, Van Aelst F, Tanghe W. Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: A prospective study in 144 consecutive patients. J Clin Ultrasound 1997;25(2):53–56. DOI: 10.1002/(sici)1097-0096(199702)25:2<53::aid-jcu1>;2-i.
  26. Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Hasegawa Y, et al. Gamma probe and ultrasonographically guided fine-needle aspiration biopsy of sentinel lymph nodes inbreast cancer patients. Eur J Surg Oncol 2001;27(2):141–145. DOI: 10.1053/ejso.2000.1059.
  27. Britton PD, Goud A, Godward S, Barter S, Freeman A, Gaskarth M, et al. Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 2009;19(3):561–569. DOI: 10.1007/s00330-008-1177-5.
  28. O'Connell AM, O'Doherty A, Malone DE. Can ultrasound evaluate axillary lymph node status in patients with breast cancer? Can Assoc Radiol J 2008;59(1):19–21.
  29. Susini T, Nori J, Olivieri S, Molino C, Marini G, Bianchi S, et al. Predicting the status of axillary lymph nodes in breast cancer: A multiparameter approach including axillary ultrasound scanning. Breast 2009;18(2):103–108. DOI: 10.1016/j.breast.2009.02.001.
  30. Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, et al. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: Role in breast cancer management. Br J Cancer 2003;88(5):702–706.
  31. Jain A, Haisfield-Wolfe ME, Lange J, Ahuja N, Khouri N, Tsangaris T, et al. The role of ultrasound-guided fine needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol 2008;15(2):462–471. DOI: 10.1245/s10434-007-9623-1.
  32. de Kanter AY, van Eijck CH, van Geel AN, Kruijt RH, Henzen SC, Paul MA, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 1999;86(11):1459–1462. DOI: 10.1046/j.1365-2168.1999.01243.x.
  33. Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 2002;95(5):982–988. DOI: 10.1002/cncr.10786.
  34. Swinson C, Ravichandran D, Nayagam M, Allen S. Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer. Eur J Surg Oncol 2009;35(11):1152–1157. DOI: 10.1016/j.ejso.2009.03.008.
  35. Tahir M, Osman KA, Shabbir J, Rogers C, Suarez R, Reynolds T, et al. Preoperative axillary staging in breast cancer—Saving time and resources. Breast J 2008;14(4):369–371. DOI: 10.1111/j.1524-4741.2008.00600.x.
  36. Khan A, Sabel MS, Nees A, Diehl KM, Cimmino VM, Kleer CG, et al. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol 2005;12(9):697–704. DOI: 10.1245/ASO.2005.09.007.
  37. Klauber-Demore N, Kuzmiak C, Rager EL, Ogunrinde OB, Ollila DW, Calvo BF, et al. High-resolution axillary ultrasound is a poor prognostic test for determining pathologic lymph node status in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer. Am J Surg 2004;188(4):386–389. DOI: 10.1016/j.amjsurg.2004.06.022.
  38. Oruwari JU, Chung MA, Koelliker S, Steinhoff MM, Cady B. Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer. Am J Surg 2002;184(4):307–309. DOI: 10.1016/s0002-9610(02)00957-1.
  39. Herrada J, Iyer RB, Atkinson EN, Sneige N, Buzdar AU, Hortobagyi GN. Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res 1997;3(9):1565–1569. PMID: 981584.
  40. Kuerer HM, Newman LA, Fornage BD, Dhingra K, Hunt KK, Buzdar AU, et al. Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer. Ann Surg Oncol 1998;5(8):673–680. DOI: 10.1016/s0002-9610(00)00382-2.
  41. Vlastos G, Fornage BD, Mirza NQ, Bedi D, Lenert JT, Winchester DJ, et al. The correlation of axillary ultrasonography with histologic breast cancer downstaging after induction chemotherapy. Am J Surg 2000;179(6):446–452. DOI: 10.1016/s0002-9610(00)00382-2.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.