Normal and pathological axillary lymph nodes

Case contributed by Gerard Carbo

Normal and pathologic axillary lymph nodes characteristics.

Case Discussion

FEATURES OF NORMAL AXILLARY LYMPH NODES

  • Normal LN should be oval and have a smooth well-defined margin. The cortex should be slightly hypoechoic on US and uniformly thin, measuring 3 mm or less.
     

FEATURES SUGGESTING METASTATIC AXILLARY LYMPH NODES

  • Cortical thickening (> 3 mm) with or without focal bulges (especially asymmetrical, irregular or inhomogeneous)
  • Complete or partial loss or disruption of central fatty hilum
  • Complete or partial replacement of LN with an ill-defined or irregular mass
  • Rounded morphology or irregular margins
  • Short axis greater than long axis 
  • Presence of abnormal color Doppler flow
  • Microcalcifications may be seen similar to the primary tumor
  • Perifocal edema on MRI (↑ T2 in the surrounding fat)
  • Lymph node with indistinct or spiculated margins and perinodal fatty infiltration suggest extranodal extension (poor prognosis)

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