الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This current study was carried out on 20 female patients presented with symptoms related to breast lesions. 15 (75%) out of 20 patients were suffering from painless mass, 3 (15%) were suffering from pain, 2(10%) were suffering from painful mass and the residual 2(10%) patients suffering from discharge referred to the Radiology Department for further evaluation. Their age ranged from 32 to 60 years with a mean age of 47.5 years.
The aim of the current study was to evaluate the role of ultrasound in differentiation between benign and malignant axillary lymph nodes in case of breast lesions.
In the current study, all patients were subjected to full history taking, thorough clinical examination and all patients were investigated by mammography, Conventional ultrasonography for the breast and axilla, Color Doppler ultrasonography for the axilla, where these imaging studies were correlated with histopathology.
The patients’ distribution regarding final pathological diagnosis were 6 benign breast lesions either breast abscess in 2 cases or fibro adenoma in 1 case or mastitis in 3 cases and 14 were malignant lesions.
In the majority of cases the lesion was located in upper outer quadrant in 10 cases (50%), followed by retroareolar region in 6 cases (30%) followed by lower outer quadrant 2 (10%), and finally the upper inner and lower inner of the same percent (5%).
The size of the primary lesions was T1 (2cm) in 2cases (14.3%), and T2(2-5 cm) in 12 cases(85.7%) of the 14 malignant
14.3% (2/14) of 14 malignant lymph nodes had a primary lesion of T1 (2 cm) and 85.7% (14/) had a primary lesion of T2 (2-5 cm). Which means that as breast cancers increase in size, the likelihood of axillary lymph node involvement increases.
Differentiating malignant from benign lymph nodes in the present study was by observing certain sonographic features like size, shape, morphological findings including echogenic hilum and cortical morphology, and Doppler criteria including resistive index, pulsatility index and vascular flow.
Size alone was not a useful criterion for distinguishing normal from abnormal axillary lymph nodes; there was no statistically significant differences between the benign and malignant lymph nodes by using the longest diameter.
The globular shape assessed by the L/S ratio. Most of the examined lymph nodes in benign breast lesions maintained the normal shape of lymph nodes at which the longest axis was more than the shortest axis, while in most of malignant cases, the normal characters of lymph nodes were lost as their shape became more or less rounded, the longest diameter became closer to the shortest diameter. L/S was ≤ 2 in 78.6% of malignant lymph nodes (11/14), while it was >2 in (83.3%) of the benign lymph nodes (5/6).
Absent hilum was significant criteria in differentiating malignant from benign lymph nodes; all benign lymph nodes showed a preserved echogenic hilum , while in malignant lymph node (57.1%)8 out of 14 malignant cases showed absent hilum. Of the 8 lymph nodes with absent echogenic hilum 100% were malignant. while 2(14.3%) showed reduced central hilum and 4 (28.6%) showed eccenric hilium .which means that all malignant nodes showed hilar changes either absence or reduced or being eccentric.
Cortical thickness of at least more than 3 mm was found in 42% of malignant nodes. Asymetrical cortical thickening was observed in 28.6(4/14) of malignant and non of benign lymph nodes.
Our results confirmed that flow patterns (such as central or peripheral) , flow velocity ratio (like pulsatility index (PI) which reflect peripheral vessel obstruction and resistivity index (RI) which reflect increased peripheral arterial resistance) can help differentiating metastatic from reactive lymph nodes ,as our work shows the following results :
Peripheral flow pattern was observed in 78.6% (11/14) of malignant lymph nodes while 83.3% (5/6) of benign lymph nodes had central flow.
the RI was relatively increased in malignant lymph nodes than in benign ones, its mean value in malignant nodes was 0.78 ± 0.11 and that of benign nodes was 0.59 ± 0.05 (p value = 0.001.) The difference was significant and found to be useful for differentiating benign from malignant nodes. 78.6 % of malignant cases had RI > 0.7 while all benign lymph nodes had RI < 0.7 with significant difference between benign and malignant groups.
The PI was relatively increased in malignant lymph nodes than in benign ones, its mean value in malignant lymph nodes was1.70 ± 0.51 and that of benign was1.09 ± 0.23 and we found that 78% (11/14) of malignant lymph nodes had a PI> 1.5. While all benign lymph nodes (6/6) had RI < 1.5 with significant difference between benign and malignant groups.
All these criteria could be helpful to distinguish benign from malignant lymph nodes and could be used to identify nodes that merit imaging guided biopsy.
US is successful and reliable in the determination of axillary metastatic involvement in cases of breast cancer. Inclusion of axillary US in the preoperative diagnostic evaluation would be complementary to sentinel node biopsy, and also could eliminate the need for it in patients with positive US results, after confirmation with biopsy.