Diagnosis of lymph node metastasis

Palpation. The main and most available method of examination axillary-subclavian and supraclavicular lymph collectors in patients with primary breast cancer is palpation. Only a few patients thick fatty tissue or excessive development of axillary process, the availability of additional lobules of the breast hamper inspection and does not allow to assess the size and consistency of the lymph nodes. The latter also applies to palpation supraclavicular nodes in cases where their deep bedding for collarbone in patients with short neck prevents the determination of the size and consistency.
It is necessary to emphasize the importance methodologically correct and consistent examine the patient, in particular the need to feelings of axillary and supraclavicular nodes in two positions. When such inspection is possible to examine the fingers of both surface and deep divisions armpit, to penetrate beneath the chest wall muscle in subclavian region, consistently to touch nodes located in transverse artery neck, collarbone, in the course of the jugular veins and, most importantly, the insertion of the sternocleidomastoid muscle to the collarbone.
With metastatic spread to the lymph nodes, with typically photoelasticity consistency and rounded or Bobovdol form, sealed, increase, and sometimes merge into a conglomerate that does the whole basin. Apparently metastases in the axillary or supraclavicular nodes, as already indicated, used to define and classify as a single, in the form of a chain, and in the form of a conglomerate of nodes. They may have different smexiest in relation to surrounding tissues and skin. In particular, in the supraclavicular area metastases may be single and be localized to the site of Troisie *, surface nodes, as well as to merge into a single conglomerate, located in the depths of depression, often performing her and squeeze the cervical plexus.
The increase, the seal, the relationship with the surrounding tissues, the loss of mobility - unconditional signs of metastatic lymph nodes that are installed on palpation.
Much more difficult on the basis of clinical examination to diagnose metstaticescoe defeated by palpation when unchanged lymph nodes. In such cases, the clinical examination is clearly insufficient, and this explains the considerable differences between the clinical evaluation and histological research of remote lymph nodes. According to our data (a holding S. A., Dymarsky L. Yu, 1975), metastases are found in 40% of patients when viewed not found changes axillary lymph nodes. On the contrary, when establishing preoperative clinical diagnosis of metastatic lesions histological confirmation is not received 25% of patients. Still large discrepancies between palpation and histological data are observed when assessing the status of supraclavicular lymph nodes. Simultaneously excision unchanged supraclavicular nodes during the extended operations allowed in 15 out of 53 (28,3%) patients to detect metastases. According to Haagensen et al. (1969), such latent changes found by 25,1% of patients. Thus, the data palpation before the operation, although they are of great importance for assessing the state of regional lymphatic collectors, still do not reflect their true status. It is necessary to apply additional methods of examination, as in identifying hidden flowing metastatic lesions in patients with primary tumors and in medical examination of previously treated.

* The site of Troisie - the medial from a chain of nodes, lying along the transverse arteries of the neck, is in the area of mergers and internal jugular, subclavian veins and usually located behind the legs of the sternocleidomastoid muscles that attach to the medial edge of the clavicle.