RadioGraphics
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/rg.27si075502
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Abe, H.
Right arrow Articles by Newstead, G. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Abe, H.
Right arrow Articles by Newstead, G. M.
Related Collections
Right arrow Breast (Imaging and Interventional)
Right arrow Ultrasound
Right arrow Oncologic Imaging

US-guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It1

Hiroyuki Abe, MD, PhD, Robert A. Schmidt, MD, Charlene A. Sennett, MD, Akiko Shimauchi, MD, PhD, and Gillian M. Newstead, MD

1 From the Section of Breast Imaging, Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637. Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received February 6, 2007; revision requested March 16 and received April 9; accepted April 18. R.A.S. is a minor stockholder with Hologic/R2 Technology, received research grants from Fuji Medical USA and Konica Minolta, and is a consultant and member of the advisory board for Konica Minolta; G.M.N. received research support from Fuji Medical USA and Philips Medical, is a member of the advisory board for Konica Minolta, and is with the speakers’ bureau of Bayer; all remaining authors have no financial relationships to disclose.

Figure 1A
View larger version (142K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1a.  (a) US image shows a normal lymph node with a thin cortex (arrowheads) and a large fatty hilum (arrows). (b) Color Doppler US image shows normal bidirectional hilar blood flow (arrow).

 

Figure 1B
View larger version (134K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1b.  (a) US image shows a normal lymph node with a thin cortex (arrowheads) and a large fatty hilum (arrows). (b) Color Doppler US image shows normal bidirectional hilar blood flow (arrow).

 

Figure 2A
View larger version (127K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2a.  (a) US image shows a normal lymph node with a thin cortex (arrowheads) and a fatty hilum (arrows) (cf Fig 1a). (b) Color Doppler US image demonstrates an adjacent vein (arrow). Lymph nodes are often located near vessels and nerves.

 

Figure 2B
View larger version (130K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2b.  (a) US image shows a normal lymph node with a thin cortex (arrowheads) and a fatty hilum (arrows) (cf Fig 1a). (b) Color Doppler US image demonstrates an adjacent vein (arrow). Lymph nodes are often located near vessels and nerves.

 

Figure 3
View larger version (104K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3.  US image shows an abnormal lymph node with a uniformly thickened cortex (arrowheads). The thickness of the cortex exceeds that of the fatty hilum.

 

Figure 4A
View larger version (134K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4a.  (a) US image shows an abnormal lymph node with asymmetric cortical thickening (arrow). (b) Color Doppler US image shows normal hilar blood flow as well as abnormal (nonhilar cortical) blood flow (arrow), with the latter finding probably representing enlarged capsular vessels.

 

Figure 4B
View larger version (129K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4b.  (a) US image shows an abnormal lymph node with asymmetric cortical thickening (arrow). (b) Color Doppler US image shows normal hilar blood flow as well as abnormal (nonhilar cortical) blood flow (arrow), with the latter finding probably representing enlarged capsular vessels.

 

Figure 5A
View larger version (97K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5a.  (a) US image shows an abnormal lymph node with a hypoechoic thickened cortex (arrowheads) but no fatty hilum. (b) Color Doppler US image shows only abnormal (nonhilar cortical) blood flow (arrows); no normal hilar blood flow is seen.

 

Figure 5B
View larger version (123K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5b.  (a) US image shows an abnormal lymph node with a hypoechoic thickened cortex (arrowheads) but no fatty hilum. (b) Color Doppler US image shows only abnormal (nonhilar cortical) blood flow (arrows); no normal hilar blood flow is seen.

 

Figure 6A
View larger version (55K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6a.  Biopsy performed with the Achieve needle (Cardinal Health). (a) Photograph shows the biopsy device. Arrow indicates the "A" button, which the operator presses to release the outer cutting cannula. (b) Presampling US image with corresponding drawing shows how, after the needle has been inserted through the target lesion (arrowheads), the outer cutting cannula (black arrows) is cocked (pulled back) and the trough (short white arrows) is opened. At this point, the system is "charged" for releasing the outer cutting cannula. Long white arrow indicates the needle tip. (c) Postsampling US image with corresponding drawing shows how, when the "A" button is pressed, the spring-loaded cannula is released and the trough is covered, thereby retrieving the sample (short arrows). Note that the needle tip (long arrow) remains in the same position between pre- and postsampling (cf b). Arrowheads indicate the target lesion. (d) Color Doppler US image shows how biopsy can be performed even for a lymph node located right next to the axillary vein (large arrow), since the needle tip (small arrow) does not move during sampling. In this case, the distance between the axillary vein and the needle tip is less than 1 mm. Indeed, we have encountered no complications even when performing a biopsy with the needle tip almost touching the wall of a vessel.

 

Figure 6B
View larger version (140K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6b.  Biopsy performed with the Achieve needle (Cardinal Health). (a) Photograph shows the biopsy device. Arrow indicates the "A" button, which the operator presses to release the outer cutting cannula. (b) Presampling US image with corresponding drawing shows how, after the needle has been inserted through the target lesion (arrowheads), the outer cutting cannula (black arrows) is cocked (pulled back) and the trough (short white arrows) is opened. At this point, the system is "charged" for releasing the outer cutting cannula. Long white arrow indicates the needle tip. (c) Postsampling US image with corresponding drawing shows how, when the "A" button is pressed, the spring-loaded cannula is released and the trough is covered, thereby retrieving the sample (short arrows). Note that the needle tip (long arrow) remains in the same position between pre- and postsampling (cf b). Arrowheads indicate the target lesion. (d) Color Doppler US image shows how biopsy can be performed even for a lymph node located right next to the axillary vein (large arrow), since the needle tip (small arrow) does not move during sampling. In this case, the distance between the axillary vein and the needle tip is less than 1 mm. Indeed, we have encountered no complications even when performing a biopsy with the needle tip almost touching the wall of a vessel.

 

Figure 6C
View larger version (119K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6c.  Biopsy performed with the Achieve needle (Cardinal Health). (a) Photograph shows the biopsy device. Arrow indicates the "A" button, which the operator presses to release the outer cutting cannula. (b) Presampling US image with corresponding drawing shows how, after the needle has been inserted through the target lesion (arrowheads), the outer cutting cannula (black arrows) is cocked (pulled back) and the trough (short white arrows) is opened. At this point, the system is "charged" for releasing the outer cutting cannula. Long white arrow indicates the needle tip. (c) Postsampling US image with corresponding drawing shows how, when the "A" button is pressed, the spring-loaded cannula is released and the trough is covered, thereby retrieving the sample (short arrows). Note that the needle tip (long arrow) remains in the same position between pre- and postsampling (cf b). Arrowheads indicate the target lesion. (d) Color Doppler US image shows how biopsy can be performed even for a lymph node located right next to the axillary vein (large arrow), since the needle tip (small arrow) does not move during sampling. In this case, the distance between the axillary vein and the needle tip is less than 1 mm. Indeed, we have encountered no complications even when performing a biopsy with the needle tip almost touching the wall of a vessel.

 

Figure 6D
View larger version (148K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6d.  Biopsy performed with the Achieve needle (Cardinal Health). (a) Photograph shows the biopsy device. Arrow indicates the "A" button, which the operator presses to release the outer cutting cannula. (b) Presampling US image with corresponding drawing shows how, after the needle has been inserted through the target lesion (arrowheads), the outer cutting cannula (black arrows) is cocked (pulled back) and the trough (short white arrows) is opened. At this point, the system is "charged" for releasing the outer cutting cannula. Long white arrow indicates the needle tip. (c) Postsampling US image with corresponding drawing shows how, when the "A" button is pressed, the spring-loaded cannula is released and the trough is covered, thereby retrieving the sample (short arrows). Note that the needle tip (long arrow) remains in the same position between pre- and postsampling (cf b). Arrowheads indicate the target lesion. (d) Color Doppler US image shows how biopsy can be performed even for a lymph node located right next to the axillary vein (large arrow), since the needle tip (small arrow) does not move during sampling. In this case, the distance between the axillary vein and the needle tip is less than 1 mm. Indeed, we have encountered no complications even when performing a biopsy with the needle tip almost touching the wall of a vessel.

 

Figure 7
View larger version (90K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 7.  Clinical photograph shows how axillary core needle biopsy is performed with the patient’s arm raised and with the axilla flattened with use of a wedge pillow.

 

Figure 8
View larger version (96K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 8.  Clinical photograph illustrates the injection of anesthetic. The operator can use the needle to probe any sensitive nerves, evaluate the distance and depth of the target, and simulate the appropriate angle of the biopsy needle.

 

Figure 9
View larger version (94K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 9.  Clinical photograph shows how, after a small skin incision has been made, the biopsy needle is advanced to the target (a thickened cortex) under real-time US guidance.

 

Figure 10A
View larger version (90K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 10a.  (a) Clinical photograph shows the direction (arrow) in which the loading lever (arrowhead) is cocked once the needle tip reaches the target. (b) US image shows the biopsy needle with the loading lever cocked. The trough can now be adjusted manually to center on the target. (c) Clinical photograph shows the operator pressing the "A" button (in direction of arrow) for sampling. (d) On a US image obtained immediately after the "A" button has been pressed, the outer cutting cannula is released and the trough is closed. The tip of the needle (arrow) should not move from its presampling location.

 

Figure 10B
View larger version (114K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 10b.  (a) Clinical photograph shows the direction (arrow) in which the loading lever (arrowhead) is cocked once the needle tip reaches the target. (b) US image shows the biopsy needle with the loading lever cocked. The trough can now be adjusted manually to center on the target. (c) Clinical photograph shows the operator pressing the "A" button (in direction of arrow) for sampling. (d) On a US image obtained immediately after the "A" button has been pressed, the outer cutting cannula is released and the trough is closed. The tip of the needle (arrow) should not move from its presampling location.

 

Figure 10C
View larger version (93K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 10c.  (a) Clinical photograph shows the direction (arrow) in which the loading lever (arrowhead) is cocked once the needle tip reaches the target. (b) US image shows the biopsy needle with the loading lever cocked. The trough can now be adjusted manually to center on the target. (c) Clinical photograph shows the operator pressing the "A" button (in direction of arrow) for sampling. (d) On a US image obtained immediately after the "A" button has been pressed, the outer cutting cannula is released and the trough is closed. The tip of the needle (arrow) should not move from its presampling location.

 

Figure 10D
View larger version (109K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 10d.  (a) Clinical photograph shows the direction (arrow) in which the loading lever (arrowhead) is cocked once the needle tip reaches the target. (b) US image shows the biopsy needle with the loading lever cocked. The trough can now be adjusted manually to center on the target. (c) Clinical photograph shows the operator pressing the "A" button (in direction of arrow) for sampling. (d) On a US image obtained immediately after the "A" button has been pressed, the outer cutting cannula is released and the trough is closed. The tip of the needle (arrow) should not move from its presampling location.

 

Figure 11
View larger version (123K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 11.  Photograph shows a biopsy specimen on the trough of the needle. The white component (lymph node cortex [arrow]) is metastatic tumor, and the yellow component (arrowheads) is adjacent fatty tissue.

 

Figure 12
View larger version (90K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 12.  Photograph shows two core samples, taken from an axillary lymph node, in a jar filled with 10% formalin solution. As is typically the case, the lymph node cortical component (black arrow) or tumor component (white arrow) of the specimen sinks in the formalin solution, whereas the fatty tissue (arrowheads) floats. Because the trough of the biopsy needle is often longer than the lymph node, adjacent fatty tissue is usually sampled together with the target cortex.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOGRAPHICS RADIOLOGY RSNA JOURNALS ONLINE
Copyright © 2007 by the Radiological Society of North America.