Palpation of the axillary nodes in breast cancer: What does the surgeon feel?

Abstract

The findings on routine pre-operative palpation of the axilla in patients with infiltrative breast carcinoma are compared to the results of histological quantitation of the nodal lymphoid tissue and its tumour deposits in 91 consecutive cases in which a standardized axillary dissection had been carried out. The study demonstrates that lymphoid tissue, even when present in large amounts (up to 6 cm2 on histology), is seldom palpable. What the clinician identifies in favourable cases is the tumour deposit itself. When little lymphoid tissue is present very small tumour deposits (0.2 cm2) may be found on palpation, but large deposits (1 cm2) may be missed when surrounded by sufficient lymphoid tissue. These findings go far to explain the well documented unreliability of the nodal findings on axillary palpation in breast cancer.

Accuracy of computed tomography perfusion in assessing metastatic involvement of enlarged axillary lymph nodes in patients with breast cancer

“…The changes induced by metastatic cells implanted in a lymph node are mainly expressed by blood vessel overgrowth and architectural disorganization [ 26 ]. Neoplastic and inflammatory infiltration have a similar behavior when invading extravascular space, and the difference between inflammatory and malignant changes is difficult to appreciate on the basis of criteria such as size [ 27 ] or even function of lymph node, as demonstrated by the similar pattern often observed by USPIO-MRI images [ 13 , 15 , 28 ]. This could be one of the reasons why we observed no differences in PS and MTT of metastatic and inflammatory enlarged axillary nodes: PS reflects the rate of leakage from the intravascular to extravascular-extracellular space within the capillary bed and MTT reflects the transit time through the vascular bed, being predominantly affected by the presence of shunts.…”

Axillary Lymph Nodes in Breast Cancer: Is Size Related to Metastatic Involvement?

“…Similar to detection by ultrasonography, alteration of lymph node structure seems to be important for axillary palpation. Hartveit et al [25] reported that normal lymphoid tissue, even when present in large amounts (up to 1.5 cm), is seldom palpable. They also showed that nodes that contain tumor deposits are more likely to be palpable than those without deposits.…”

“…According to our results axillary lymph node metastases are seen in lymph nodes of all sizes. Harveit et al [25] suggested that the clinician, in fact, in favorable cases identifies on palpation not the enlarged lymph node tissue but the tumor deposit itself, which alters the character of the palpation. Certainly there are other aspects (e.g., the body mass index) that could disturb palpation; but similar to that for ultrasonography [7][8][9], the lymph node structure and "quality" of nodes seem more important than their enlargement.…”

Evaluación preoperatoria con ultrasonido de los ganglios axilares en la paciente con diagnóstico reciente de cáncer de mama

“…En caso de que la biopsia sea positiva, se debe realizar vaciamiento axilar, el cual es la conducta más aceptada. En el caso de que el estudio preoperatorio sea negativo debe estadificarse la axila mediante cirugía (biopsia de ganglio centinela), y en caso positivo se realiza vaciamiento axilar; de lo contrario, (negativo), se omite el vaciamiento axilar [7][8][9][10][11][12][13] .…”

“…La evaluación preoperatoria de la axila incluye la exploración clínica por parte del cirujano y los estudios de imagen. La evaluación por palpación directa detecta ganglios de alrededor de 15 mm y sabemos que tiene una muy baja sensibilidad 9,11 . En la mamografía utilizada para la evaluación y el escrutinio del cáncer de mama solo se incluye una zona pequeña de la axila, por lo que también posee unas bajas sensibilidad y especificidad.…”