Routine breast imaging studies frequently detect abnormal axillary lymph node findings including increase in node density, interval increase in size, loss of the normal fatty hilum, and calcification.1 The presence of calcified axillary lymph nodes is significant because it can be the only finding indicative of serious regional or systemic disease. Although primary breast cancer has been associated with axillary lymph node calcifications, familiarity with additional local and systemic processes presenting in this manner can aid in planning further diagnostic evaluation of patients. In many cases, it will not be possible to distinguish benign and malignant axillary lymph nodes on mammography alone; therefore, fine-needle aspiration, preferably with ultrasound guidance, or biopsy of the lymph nodes will be needed for further evaluation. However, after an appropriate review for likely benign etiologies, it may be possible to limit the number of unnecessary invasive procedures.
Dr. Johnson is Clinical Instructor in Radiology and Biomedical Imaging, Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143; E-mail: firstname.lastname@example.org; Dr. Franceschi is Resident, Department of Radiology, SUNY at Stony Brook, Stony Brook, New York; Dr. Reed is Resident, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut; Dr. Primm is Radiologist, Elliot Health System, Manchester, New Hampshire; and Dr. Herschorn is Associate Professor of Radiology, University of Vermont, Burlington, Vermont.
After participating in this activity, the diagnostic radiologist should be better able to evaluate the potential implications of calcified axillary lymph nodes as identified on routine breast imaging studies.
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