Diagnostic and Therapeutic Axillary Ultrasound
Physical exam for enlarged and suspicious axillary lymphadenopathy is often inaccurate. The accuracy of the physical exam is often dependent on the patient’s body habitus. A more accurate method to identify patients with suspicious appearing lymph nodes is pre-operative axillary ultrasound.
For most patients with invasive breast cancer, if the axillary ultrasound is negative, sentinel lymph node biopsy is performed at the time of the breast operation to make sure the cancer has not spread.
If the pre-operative axillary ultrasound reveals suspicious lymph nodes, a fine needle aspiration biopsy of the abnormal lymph nodes is performed. If lymph node metastases are identified, the patient can be spared the time, cost and morbidity of a sentinel lymph node biopsy and proceed directly with a definitive axillary lymph node dissection. In addition, depending on the patient’s tumor biology, if lymph node metastases are identified, other treatment strategies can be discussed with the patient such as giving chemotherapy before surgery.
More research is planned, including the future possibility of perhaps avoiding axillary lymph node surgery altogether in some breast cancer patients with small tumors and negative axillary ultrasounds. [SOUND trial is underway: (Sentinel Node vs. Observation After Axillary Ultrasound)]