Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study

Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study
Deepak G. Bedi, Rajesh Krishnamurthy, Savitri Krishnamurthy, Beth S. Edeiken, Huong Le-Petross, Bruno D. Fornage, Roland L. Bassett, Jr., and Kelly K. Hunt
AJR 2008;191:646-652

Link to Journal

CONCLUSION.
In breast cancer, axillary lymph nodes can be classified according to cortical morphologic features. Predominantly hyperechoic nodes (types 1–3) can be considered benign. Generalized cortical lobulation (type 4) is uncommonly a false-negative finding, but metastasis, if present, is invariably detected at sentinel node mapping.

The presence of asymmetric focal hypoechoic cortical lobulation (type 5) or a completely hypoechoic node (type 6) should serve as a guideline for universal performance of fine-needle aspiration for preoperative staging of breast cancer. This classification, when verified with larger samples, may serve as a useful clinical guideline if proven with results of in vivo studies.

One of my criticisms of this paper is the absence of mention of the Nottingham Criteria for abnormal lymph nodes requiring biopsy. The original paper was published in 2003 in the British Journal of Cancer, and did not get the publicity it deserved.

Axillary ultrasound is now a routine procedure for patients with cancer, especially important in patients entering neo-adjuvant treatment or trials (such as I-SPY), where the pre-chemo demonstration of positive nodes may be the only evidence of stage 3 disease.