The safety and efficiency of the ultrasound-guided large needle core biopsy of axilla lymph nodes

Abstract

Purpose: To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes.

Materials and methods: From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nodes found during breast ultrasonography to find out whether the patients had a history of breast cancer or not. Among the 31 patients, 16 patients were associated with breast cancer. The lesion sizes varied from 0.6 cm to 3.3 cm (mean=1.59+/-0.76 cm). US-guided core biopsies were performed with 14 G needles with an automated biopsy gun. Total 3 or 5 specimens were obtained.

Results: Among the 31 cases of axilla lymph nodes core biopsies, 11 cases showed malignant pathology. Seven out of 11 cases were metastatic lymph nodes from breast cancer; 2 cases were from primary unknown and 2 cases from lymphomas. On the other hand, 20 histopathologic results of axilla lesions were benign: subacute necrotizing lymphadenitis (n=2), dermatopathic lymphadenitis (n=1), reactive hyperplasia (n=10) and free of carcinoma (n=7).

Conclusion: The US-guided large needle core biopsy of axilla lesions is safe and effective for the pathological evaluation. The core biopsy is believed to be easy to perform if suspicious lymph nodes or mass lesions are found in the axilla.

Figures

Fig. 1

A 51-year-old woman with a metastatic lymph node in the right axilla. (A) The mediolateral oblique view of mammography shows an enlarged high density lymph node in the right axilla without mass or microcalcifications in the right breast. (B) Ultrasonography revealed a 1.48 × 0.71 cm sized hypoechoic lymph node in the right axilla, showing loss of a fatty hilum. (C) The ultrasound guided 14-gauge automated core biopsy was performed at the axilla lymph node, and the real time visualization of the needle was achievable. (D) A large needle (14-gauge) lymph node specimen (H&E stain, ×20) shows the cores of metastatic carcinoma occupying almost the entire biopsied lymph node tissue. (E) Photomicrograph shows clusters of infiltrating metastatic carcinoma cells on the right side of view (H&E, ×400).

Fig. 2

A 50-year-old woman with contralateral metastatic axillary lymph node after right modified radical mastectomy 2 years ago. (A) Single enlarged axillary lymph node with eccentric cortical thickening is noted in the left axilla. The size of the lymph node is 2.0 × 1.5 cm. (B) The ultrasonography guided large needle core biopsy shows correct sampling for the eccentric lymph node cortex. (C) The dissected axillary lymph node shows infiltration of the metastatic carcinoma (lower left, H&E, ×100). The lymph node parenchyma shows partial fibrosis due to previous chemotherapy. (D) The core shows infiltration of the metastatic carcinoma (H&E, ×100).

Fig. 3

A 40-year-old woman with left modified radical mastectomy 5.5 years ago. (A) Post-op follow up ultrasonography shows eccentric cortical thickening of the contralateral axillary lymph node, which was proved to be the metastatic lymph node by the core biopsy using 14 gauge large needle. (B) After chemotherapy, the size of the metastatic axillary lymph node was reduced from 15 to 8 mm in the largest dimension.