Features of Ultrasonic Anatomy of the Parasternal Region in Patients with Breast Cancer

Purpose: To evaluate the possibility of ultrasound examination of parasternal lymph nodes in patients with breast cancer and to study the ultrasound semiotics of the parasternal region to improve the results of diagnosis of breast cancer metastases.

Material and methods: The study included 35 patients aged 29 to 83 years, of which 22 primary patients diagnosed with breast cancer and localization of tumors in the central and medial departments, and 13 patients under dynamic observation, after previous treatment for breast cancer. All women underwent ultrasound examination, including examination of the breast, axillary, subclavian and supraclavicular zones, in addition, all patients underwent examination of the parasternal region. In addition, the patients underwent mammography in 2 projections, as well as computed tomography with intravenous bolus contrast gain.

Results: Of the 35 patients examined, parasternal lymph nodes were visualized in 10 patients. 4 patients had specific lymph node lesions. In 2 patients from the group of primary patients and in 2 patients from the group of patients under dynamic control after previous treatment. In the remaining 6 patients lymph nodes according to the results of cytology had signs of nonspecific reactive hyperplasia. The minimum size of the visualized lymph nodes was 4±0.5 mm. In all cases of specific lesions, according to ultrasound, the lymph node had a rounded shape, reduced echogenicity, anatomical structures of the lymph node were not differentiated, in the mode of shear wave elastography, had a rigid consistency. In 6 patients with hyperplasia, lymph nodes had a flat, elongated shape, differentiation into anatomical structures was preserved, the rim, сentral echo complex and gates of the lymph node were visualized, when assessing stiffness by shear wave elastography, lymph nodes had a soft consistency. According to computed tomography in 25 cases, when lymph nodes could not be visualized by ultrasound, they were also not detected by CT. According to CT data, 4 patients showed signs of specific lymph node lesions, rounded shape and intensive accumulation of contrast agent.

1. Линденбратен Л.Д., Королюк И.П. Медицинская радиология. - М. Медицина, 2000.

2. Лубоцкий Д.Н. Средостение и заключенные в нем органы // В кн. «Основы топографической анатомии». - М. 1953. С. 409-429.

3. Шведавченко А.И. Нечушкин М.И. Анатомо-топографические особенности окологрудинных лимфатических узлов с точки зрения методики их внутритканевого облучения // Республ. сб. научн. трудов «Вопросы эндокринологии». - М. 1983. С. 165-169.

4. Наркевич Ф.В. Роль расширенной мастэктомии в лечении рака медиальной половины и центра молочной железы // Сб. научн. трудов «Актуальные проблемы онкологии и медицинской радиологии». -Минск. 1970. Т. 2. С. 256-258.

5. Видеоторакоскопическая парастернальная лимфаденэктомия при раке молочной железы // Мат. 1 Съезда онкологов стран СНГ. - М. 1996. С. 515-516.

6. Meuwly J.Y., Gudinchet F. Sonography of the thoracic and abdominal walls // J. Clin. Ultrasound. 2004. Vol. 32. P. 500-510.

7. Mlosek R.K., Malinowska S. Ultrasound image of the skin, apparatus and imaging basics // J. Ultrasonography. 2013. Vol. 13. № 53. P. 53-57.

8. Mathis G. Horaxsonography. Part 1: Chest Wall and Pleura // Praxis. 2004. Vol. 93. P 615-621.

9. Lee R.K., Griffith J.F., Ng A.W.H., Sitt J.C. Sonography of the chest wall: A pictorial essay // J. Clin. Ultrasound. 2015. Vol. 43. P 525-537.

10. Grechenig W., Tesch PN., Clement H., Mayr J. Sonoanatomy of the muscles and fascia spaces of the pectoral regions // Ultraschall. Med. 2005. Vol. 26. P. 216-222.

11. Veronesi U., Cascinelli N., Greco M. et al. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes // Ann. Surg. 1985. Vol. 202. P. 702-707.

12. TNM Classification of Malignant Tumours. 7th ed. Sobin L.H., Gospodarowicz M.K., Wittekind Ch., eds. -New York: Wiley-Blackwell. 2009.