ULTRASOUND OF THE AXILLA…WHERE DO WE EVEN START?
By Colin P. Griffin, Liverpool University Hospitals NHS Foundation Trust
Aim:
There is a large variation in the ultrasound practitioners that undertake axillary ultrasound. Some imaging departments utilise musculoskeletal (MSK)-trained staff however others include it in the general medical departmental workload, whilst others ensure that breast-trained staff only must undertake the role. This is a problem that requires a wide variety of knowledge, skills and planning to ensure the correct practitioners will see this patient cohort.
Method:
The common pathologies that affect that axilla with a complex list of normal anatomy and variations is key to the development of robust imaging protocols and training of ultrasound practitioners. This requires an assessment of four major pathology groups routinely referred for this examination:
• Breast cancer
• MSK injuries
• Lymph node disease/disorders
• Soft tissue masses/lesions
Results:
National Health Service England currently recommends that any axillary node, with a cortex greater than 3mm requires an ultrasound-guided needle core biopsy. This however is only to be performed in the presence of invasive breast cancers. The normal thresholds for lymph node assessment in the absence of breast cancer, i.e. the short axis of the whole node should measure up to 10mm, need to be followed in the non-breast cancer group. Areas of accessory breast tissue must also be assessed for focal breast disease.
MSK pathologies are assessed in relation to the glenohumeral joint, soft tissue trauma and injury and other common MSK-related findings.
Soft tissue masses should be treated and assessed following the standard protocols to exclude sarcoma or other malignant lesions.
Conclusions:
Irrespective of the background of the ultrasound practitioner, it is clear that with: the correct training; guidelines or protocols and; understanding of the patient’s clinical background, it should not matter who undertakes the assessment of the axilla.