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Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study

Deepak G. Bedi1, Rajesh Krishnamurthy2, Savitri Krishnamurthy3, Beth S. Edeiken1, Huong Le-Petross1, Bruno D. Fornage1, Roland L. Bassett, Jr.4 and Kelly K. Hunt5

1 Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX 77030.
2 Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX.
3 Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
4 Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
5 Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.


Figure 1
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  		Fig. 1 —Diagram shows anatomic features of lymph node. Hypoechoic cortex (C) on sonogram represents marginal sinus, lymphoid follicles (F), and paracortex (P). Paracortex occasionally is slightly more hyperechoic (Fig. 3) owing to fat infiltration from hilum (Fig. 7B). Hilum (H) is hyperechoic owing to multiple reflective interfaces of blood vessels, fat, and central sinus.

 

Figure 2
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  		Fig. 2 —47-year-old woman with infiltrating ductal carcinoma. Intraoperative photograph of sentinel node shows isosulfan blue dye opacifying multiple afferent lymphatic channels. N = node.

 

Figure 3
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  		Fig. 3 —33-year-old woman with infiltrating ductal cancer. Sonogram of benign lymph node shows hypoechoic cortex (C) with slightly hyperechoic paracortex (P) can be correlated to outer zone of lymphoid tissue in Figure 1. Hilum (H) is hyperechoic, representing central sinus, medullary cords, blood vessels, and fat. Afferent and efferent vessels cannot be seen with sonography.

 

Figure 4
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  		Fig. 4A —54-year-old woman with invasive ductal carcinoma and benign node (type 1). Sonogram (A), histopathologic photograph (B), and diagram (C) show almost no cortex (arrows), which is more evident in B. Hilum (H) has paradoxically hypoechoic areas due to presence of relatively few vessels and mostly homogeneous fat cells and lacks many reflective interfaces. Relatively hyperechoic areas correlate with vessels and trabeculae.

 

Figure 5
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  		Fig. 4B —54-year-old woman with invasive ductal carcinoma and benign node (type 1). Sonogram (A), histopathologic photograph (B), and diagram (C) show almost no cortex (arrows), which is more evident in B. Hilum (H) has paradoxically hypoechoic areas due to presence of relatively few vessels and mostly homogeneous fat cells and lacks many reflective interfaces. Relatively hyperechoic areas correlate with vessels and trabeculae.

 

Figure 6
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  		Fig. 4C —54-year-old woman with invasive ductal carcinoma and benign node (type 1). Sonogram (A), histopathologic photograph (B), and diagram (C) show almost no cortex (arrows), which is more evident in B. Hilum (H) has paradoxically hypoechoic areas due to presence of relatively few vessels and mostly homogeneous fat cells and lacks many reflective interfaces. Relatively hyperechoic areas correlate with vessels and trabeculae.

 

Figure 7
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  		Fig. 5A —54-year-old woman with invasive ductal carcinoma and benign type 2 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform thin hypoechoic cortex (arrows) less than 3 mm thick. B shows thin cortex around hilum (H).

 

Figure 8
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  		Fig. 5B —54-year-old woman with invasive ductal carcinoma and benign type 2 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform thin hypoechoic cortex (arrows) less than 3 mm thick. B shows thin cortex around hilum (H).

 

Figure 9
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  		Fig. 5C —54-year-old woman with invasive ductal carcinoma and benign type 2 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform thin hypoechoic cortex (arrows) less than 3 mm thick. B shows thin cortex around hilum (H).

 

Figure 10
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  		Fig. 6A —49-year-old woman with invasive ductal carcinoma and benign type 3 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform cortex thicker than 3 mm and minor surface lobulations (arrows, A and B). Hyperechoic hilum (H) has more reflective interfaces than node in Figure 4A, 4B, 4C.

 

Figure 11
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  		Fig. 6B —49-year-old woman with invasive ductal carcinoma and benign type 3 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform cortex thicker than 3 mm and minor surface lobulations (arrows, A and B). Hyperechoic hilum (H) has more reflective interfaces than node in Figure 4A, 4B, 4C.

 

Figure 12
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  		Fig. 6C —49-year-old woman with invasive ductal carcinoma and benign type 3 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show uniform cortex thicker than 3 mm and minor surface lobulations (arrows, A and B). Hyperechoic hilum (H) has more reflective interfaces than node in Figure 4A, 4B, 4C.

 

Figure 13
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  		Fig. 7A —52-year-old woman with invasive intraductal carcinoma and benign type 4 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show cortical lobulations (arrows) are generalized and follow contour of hilar echogenicity. Cortex appears thinner on A because of hilar fat infiltration into paracortex (arrowheads, A and B). H = hilum.

 

Figure 14
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  		Fig. 7B —52-year-old woman with invasive intraductal carcinoma and benign type 4 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show cortical lobulations (arrows) are generalized and follow contour of hilar echogenicity. Cortex appears thinner on A because of hilar fat infiltration into paracortex (arrowheads, A and B). H = hilum.

 

Figure 15
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  		Fig. 7C —52-year-old woman with invasive intraductal carcinoma and benign type 4 node. Sonogram (A), histopathologic photograph (B), and diagram (C) show cortical lobulations (arrows) are generalized and follow contour of hilar echogenicity. Cortex appears thinner on A because of hilar fat infiltration into paracortex (arrowheads, A and B). H = hilum.

 

Figure 16
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  		Fig. 8A —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (A), low-power histopathologic photograph (B), and diagram (C) show type 5 node characterized by focal hypoechoic lobulation of cortex (arrows) due to metastatic deposit (T). H = hilum.

 

Figure 17
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  		Fig. 8B —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (A), low-power histopathologic photograph (B), and diagram (C) show type 5 node characterized by focal hypoechoic lobulation of cortex (arrows) due to metastatic deposit (T). H = hilum.

 

Figure 18
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  		Fig. 8C —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (A), low-power histopathologic photograph (B), and diagram (C) show type 5 node characterized by focal hypoechoic lobulation of cortex (arrows) due to metastatic deposit (T). H = hilum.

 

Figure 19
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  		Fig. 8D —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (D), histopathologic photograph (E), and diagram (F) show type 6 completely hypoechoic node with no hilum owing to metastatic replacement (T).

 

Figure 20
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  		Fig. 8E —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (D), histopathologic photograph (E), and diagram (F) show type 6 completely hypoechoic node with no hilum owing to metastatic replacement (T).

 

Figure 21
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  		Fig. 8F —42-year-old woman with invasive ductal carcinoma and metastatic type 5 and 6 nodes. Sonogram (D), histopathologic photograph (E), and diagram (F) show type 6 completely hypoechoic node with no hilum owing to metastatic replacement (T).

 

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