Sonographic evaluation of axillary lymph nodes in women with newly diagnosed breast cancer at the university college hospital Ibadan, Nigeria

Niger Postgrad Med J. 2018 Apr-Jun;25(2):79-86. doi: 10.4103/npmj.npmj_74_18.


Background: Axillary lymph node (LN) status of patients with breast cancer is important in the surgical management. Sonographic evaluation of axillary LNs in newly diagnosed breast cancer is required to predict prognosis.

Objective: The purpose of this study was to describe the morphologic features by sonographic evaluation of the cortices and sinuses as well as patterns of blood flow of axillary LNs and correlate same with the clinical staging in women with newly diagnosed breast cancer in a tertiary referral centre.

Patients and methods: This was a prospective and descriptive study of 106 newly diagnosed female breast cancer patients recruited from the surgical outpatient clinic of the University College Hospital, Ibadan, during a period of 9 months in 2015. All 106 patients had clinical evaluation, sociodemographic documentation and ultrasound scans of the breast and axillae performed.

Results: The mean age of patients was 48.1 (±11.1) years with age range 20-82 years. Most patients have a negative family history of breast cancer as seen in 97 (91.4%) of them. Abnormal cortex-hilum area ratio was more frequent in the right (66.7%) than the left (41.2%) axillary LNs. Longitudinal-transverse ratio was abnormal in 93.5% and 86.3% of LNs in the right and left axillae, respectively. Slit-like hilum, eccentric cortical thickening, replaced node and rat-bite appearance, respectively, were found in 40.7%, 10.4%, 48.4% and 44.4% of LNs in the right axilla. The peripheral flow type was demonstrated in 46.8% and 48.1% of LNs in the right and left axillae, respectively.

Conclusion: Ultrasonography is a good diagnostic tool that can be employed with reasonable accuracy in the initial assessment of axillary involvement in breast cancer. Although the assessment of tumour size and clinical staging leaves little doubt as to the stage of breast cancer disease, sonographic evaluation of the breast and the axilla painted a more ominous picture.

Keywords: Axillary lymph nodes; breast cancer; ultrasound.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla / blood supply
  • Axilla / diagnostic imaging*
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Female
  • Hospitals, University
  • Humans
  • Lymph Nodes / diagnostic imaging*
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / pathology
  • Middle Aged
  • Neoplasm Staging
  • Nigeria
  • Prospective Studies
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy / methods*
  • Ultrasonography, Doppler / methods*