THE CLINICAL IMPORTANCE OF AXILLARY LYMPHADENOPATHY DETECTED ON SCREENING MAMMOGRAPHY

The aim of this study was to determine the incidence and cause of axil lary lymphadenopathy detected by screening mammography and to devise a management protocol for this pathology, Tn a retrospective study of 9 5 806 consecutive screening mammograms, 37 cases of 'pathological' axi llary nodes were identified using two or more of the following criteri a: size >2 cm, replacement of fatty hilum, rounded shape and generaliz ed increased density, In 16 cases with an additional mammographic abno rmality, 12 had a mass (10 malignant and two benign) and four had susp icious calcification (all malignant), In 12 of these cases, the lymph nodes showed malignancy (75%), In 21 patients with lymphadenopathy alo ne on screening, six patients had a known underlying diagnosis and wer e not recalled from screening, The remaining 15 patients were recalled for further assessment including fine needle aspiration cytology (FNA C). The ultimate diagnosis was benign in 10 cases (48%) - six reactive changes, one healed granulomatous disease, one rheumatoid arthritis, one amyloid and one acute infection - and malignant in 11 cases (52%) - six non-Hodgkin's lymphoma, four metastatic carcinoma and one leukae mia, In conclusion, there is a high incidence of malignant nodal invol vement in cases of screen detected lymphadenopathy (62% of cases in ou r series). We would advise that patients with lymphadenopathy as the s ole finding on screening mammography and in whom there is no known und erlying cause should undergo FNAC followed by excision biopsy, Fifty p er cent of such patients in this study had underlying malignancy.