Management of accidentally found pathological lymph nodes on routine screening mammography

Normal lymph nodes in the anterior part of the axilla are readily seen on routine mammography. It is important, however, to recognize pathological lymph nodes, characterized by increased attenuation, high density, a round or irregular shape and lack of fat in the hilus, as they often indicate significant diseases. We examined the final diagnosis in 22 patients referred for clinical examination from a mammographic screening programme because of pathological lymph nodes without concomitant breast malignancy. Ten of them were found to have a malignant lesion, and one had sarcoidosis. None of the malignancies had been diagnosed before screening. Among women with abnormal but impalpable nodes, only one malignancy was found (in a woman with previous breast cancer), whereas nine of 13 women with palpable nodes had malignancies. Seven malignant lymphomas were discovered, but among all 60 women of the age group in question with newly diagnosed lymphomas in the region, only 13 had pathological axillary nodes. Mammography cannot therefore be used as a screening method for lymphoma. We conclude that mammographically pathological lymph nodes in the axilla should be examined clinically and propose a simple programme for patient management.