Hand Surgery Source

Lymph Node Axilla

Test, Exam and Signs

Description

  • The lymph node axilla test can check for infection, rheumatoid arthritis (RA) or axillary disease associated with breast cancer.1

Pathophysiology

  • Lymph node axillary disease can arise from breast cancer. Swollen lymph nodes may also result from infection or RA.
  • Also, lymph nodes in the axilla may temporarily swell and become tender after a Xiaflex injection for Dupuytren’s disease.2

Instructions

  1. Obtain an accurate and complete patient history, including any history of cancer.
  2. Ask the patient if he/she experiences any pain or swelling in the affected axillary area.
  3. Check if any lymph node axilla are larger than 10 mm.
  4. Palpate the area for notable enlargement or swelling.
  5. Examine the contralateral area of the lymph node axilla.

Related Signs and Tests

  • Mass tenderness
  • Sentinel lymph node biopsy (SLNB)
  • Grey-scale ultrasound3
  • Elastography3
  • MRI

Diagnostic Performance Characteristics

  • Using newer ultrasound techniques such as elastography may improve the reliability of diagnosis.3
  • MRI can be helpful to improve reliability, because it provides a global view of both axillae.4
Definition of Positive Result
  • A positive result occurs when the patient experiences any swelling, pain or inflammation in the affected area of the axillary lymph nodes and/or any are larger than 10 mm.
Definition of Negative Result
  • A negative result occurs when the patient does not experience swelling, pain or inflammation in the affected area of the axillary lymph nodes and are no larger than 10 mm.  
Comments and Pearls
  • Future possibilities for diagnosis of lymph node axilla include the use of intradermal “microbubbles” to biopsy the sentinel lymph node.3
  • If cancer is suspected, discuss with the patient the options for biopsy, ultrasound, and magnetic resonance imaging (MRI). These tests will help to differentiate between benign and malignant lymph nodes.3
Diagnoses Associated with Tests, Exams and Signs
References
  1. Pinheiro DJ, Elias S, Nazário AC. Axillary lymph nodes in breast cancer patients: sonographic evaluation. Radiol Bras2014;47(4):240-4. PMID: 25741091
  2. Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med2009;361(10):968-79. PMID: 19726771
  3. Lowes S, Leaver A, Cox K, et al. Evolving imaging techniques for staging axillary lymph nodes in breast cancer. Clin Radiol2018;73(4):396-409. PMID: 29439780
  4. Ecanow JS, Abe H, Newstead GM, et al. Axillary staging of breast cancer: what the radiologist should know. Radiographics2013;33(6):1589-612. PMID: 24108553