[Metastasis in axillary lymph nodes in breast carcinoma--possibilities of mammographic diagnosis].

INTRODUCTION Enlarged axillary lymph nodes are often found during routine examinations. They are usually circular, oval, lobular, smaller than 1 cm, with typically changed fat centers. The condition of axillary lymph nodes in breast cancer is of great importance for timely diagnosis, because its metastatic spread is a primary prognostic sign of breast cancer. Therefore, the purpose of this paper is to explore possibilities of mammographic diagnosis in detecting enlarged lymph nodes. MATERIAL AND METHODS The authors present 69 patients with enlarged axillary lymph nodes discovered by clinical examination and mammography of the axila. Of 69 patients, 47 patients had metastatic breast cancer, 21 subject had dysplasia and 1 patient had bacterial infection. Of 47 patients with breast cancer metastases, in 38 the tumour mass in breast was visible by mammography; microcalcifications had been found in 5 patients, while in 4 subjects the tumour mass was not visible either in one, or the other mamma. Biopsy was performed in all 47 patients and diagnosis was confirmed microscopically (by PH). DISCUSSION AND CONCLUSION The appearance of enlarged lymph nodes in axilla may be a primary clinical and mammographic sign of the earliest breast cancer. The diagnosis is not the problem if lymphadenopathy, together with visible cancer, is present (Figure 1). The problem arises when enlarged lymph nodes are without visible tumour mass in the breast (Figures 2 and 3), because their enlargement can also be seen in dysplasia, inflammation (Fig. 6), lymphoma, metastases of some other tumour (rarely), systemic disease. In all presented patients with metastatic breast cancer, lymph nodes were extremely enlarged, homogeneous and separated. All of them had no hylar fatty degeneration which is a characteristic of benign enlargement of lymph nodes. But, it is impossible to make a differential diagnosis between malignant changes and benign enlargement of lymph nodes by mammography. Consequently, biopsy of all lymph nodes larger than 1 cm, being not infiltrated by fat is suggested (excluding mastitis and dermatitis), because only pathology can give answer to the cause of lymph nodes enlargement.