Sonographic patterns of infra and supra-clavicular malignant lymph nodes in breast cancer patients at the Uganda cancer institute. A cross-sectional study.

CHRESPERS BIRENGESO; Valeria  Nabbosa; Margaret   Mbabazi; Nixon  Niyonzima

doi:10.51168/sjhrafrica.v7i2.2228

Authors

Chrespers Birengeso Department of ultrasound, Ecurei University.
Dr. Valeria Nabbosa Division of Oncology imaging, Uganda Cancer Institute
Dr. Mbabazi Margaret MBChB, MMED (Radiology), PHD-Fellow, Consultant Radiologist, and Lecturer ECUREI-Mengo
Dr. Nixon Niyonzima MBChB, Msc, MMed(pathology), PhD (Molecular biology). Head Research and Training Directorate UCI. Laboratory director

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2228

Keywords:

sonographic patterns, clavicular malignant lymph nodes, breast cancer, Uganda cancer institute

Abstract

Background

At the Uganda Cancer Institute, the sonographic protocol for breast imaging in malignancies mainly focuses on the breast itself and level I axillary lymph nodes. Axillary Level II, level III plus supraclavicular ultrasound scans are not routinely requested and yet are vital in early detection of lesions even before they become clinically apparent.

Methodology

This was a hospital based cross-sectional study involving 378 breast cancer patients who were randomly sampled. Those with dual malignancies were excluded. Clinical evaluation of the breasts, the axilla, the sub-clavicular, the infra and supra clavicular areas was performed followed by sonographic examination by experienced sonographers and imaging technologists.

Results

Infraclavicular and supraclavicular sonographicaly malignant lymph nodes ranged from 0.13-3.8 cm in length with a mean of 2.2 cm. Most of the lymph nodes 58% maintained their oval shape and had changes in other areas such the capsular margins (45% being irregular), cortex thickened (71.8%), unclear corticomedullary boundaries (71.3%) hilar thinning, (68.5%), calcifications (21%), necrotic changes (27.6%), and presence of flow on color Doppler which when combined together, fit our criteria for classification of lymph node as malignant. Level V (the posterior triangle of the neck) had 47.4% of the supraclavicular lymph nodes.

Conclusion

The commonest stations for supraclavicular malignant lymph nodes were Level V (the posterior triangle of the neck). The presence of flow, possession of unclear corticomedullary boundaries, thickening of the cortex were among the commonest patterns in the malignant lymph nodes.

Recommendation

All medical imaging professionals particularly those doing sonography on cancer patients and suspected cancer patients should start including the scanning of axillary levels II, III and the supraclavicular areas (at least level V, III and VII) in their protocols in addition to the normal scanning of the breast and axillary level I only.

Author Biography

Dr. Nixon Niyonzima, MBChB, Msc, MMed(pathology), PhD (Molecular biology). Head Research and Training Directorate UCI. Laboratory director

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