Ultrasound of the axilla: where to look for the sentinel lymph node

Ultrasound of the axilla: where to look for the sentinel lymph node
P. Britton, P. Moyle, J.R. Benson, A. Goud, R. Sinnatamby, S. Barter, M. Gaskarth, E. Provenzano, M. Wallis
Clinical Radiology 2010 65:373–376

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Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla.

Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB

Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes