title: Incidental Suspicious Regional Lymph Nodes on Breast Sonography: Is Sampling Necessary?
abstract: Suspicious regional lymph nodes may be incidentally identified on breast ultrasound examinations in patients who present for sonographic evaluation without a known or a suspected breast malignancy, and there is a paucity of data on whether biopsy should be performed. This study aims to characterize incidental sonographically detected suspicious regional lymph nodes and determine whether tissue sampling or follow-up imaging is required. A total of 40,773 consecutive breast ultrasounds were reviewed. Overall, 7 women with nonpalpable, incidental, suspicious axillary or supraclavicular lymph nodes in an otherwise unremarkable breast and without history of malignancy or systemic disease were identified. In all, 5 women with 6 nodes underwent ultrasound-guided fine needle aspiration and 2 women with 3 nodes were recommended follow-up ultrasound. Follow-up imaging, cytology, and all-cause clinical data were reviewed to evaluate outcomes. All 6 biopsied lymph nodes (mean = 1.5cm) were benign on cytology. Follow-up imaging was available for 3 nodes (mean = 2.6 years), with all-cause follow-up for all nodes of 2.2 years. In the follow-up group, 3 lymph nodes (mean = 1.6cm) were monitored (mean = 4.3 years) with all-cause follow-up of 4.7 years. No new cancers, growth, or suspicious features were found in these nodes during follow-up for either group of women. In conclusion, women without history of prior malignancy or systemic disease with incidentally detected, nonpalpable, suspicious regional lymph nodes with an otherwise normal breast ultrasound examination underwent fine needle aspiration or were recommended short-term follow-up ultrasound. No indeterminate features or malignancies were observed at the time of tissue sampling or developed over several years of follow-up. Avoiding sampling of these nodes would reduce patient morbidity and health care costs.
authors.affiliation: Department of Radiology, Baylor College of Medicine, Houston, TX; Department of Radiology, UT MD Anderson Cancer Center, Houston, TX. Electronic address: sean.raj@gmail.com.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Raj
authors.affiliation: Department of Radiology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Amer
authors.affiliation: Department of Radiology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Pathology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.affiliation: Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Hess
authors.affiliation: Department of Radiology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Park
authors.affiliation: Department of Radiology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Tanya
authors.initials: T
authors.lastname: Moseley
authors.affiliation: Department of Radiology, UT MD Anderson Cancer Center, Houston, TX.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Whitman
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D033162:Incidental Findings; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary