Summary
Sonography has been established as an important adjunct to current diagnostic techniques for the assessment of mammary lymph nodes. Although this method is widely used, no reproducible standard procedure which is equally applicable to the examination of all relevant lymphatic groups has been developed to date. Healthy subjects (n=50) were examined in an attempt at defining sonographic scanning levels for optimum visualization of anatomic reference landmarks. Images were acquired with a 7.5-MHz linear-array transducer. Anatomic cross-sections of the same level as imaged by sonography were used to identify important details. Unique structures close to the lymph nodes could be identified by sonography, it was not possible, however, to differentiate normal lymph nodes. The correct assessment of lymph drainage areas is therefore possible only if the sonographic level is clearly defined and if the examiner is familiar with the topographic relationships between the depicted structures. By presenting a reproducible examination technique as well as anatomic details, this study aims at avoiding false interpretations and increasing the efficacy of sonographic exploration. The authors believe that this simple and hardly time-consuming technique can contribute to a comprehensive evaluation of the lymph drainage areas of the breast.
Résumé
L'échographie des parties molles a acquis droit de cité comme complément utile des procédés classiques dans l'exploration des noeuds lymphatiques tributaires du sein. La méthode est largement utilisée, cependant aucune technique standardisée n'a été décrite qui permette d'étudier avec la même fiabilité la totalité des gites ganglionnaires. Nous avons exploré 50 sujets sains afin de préciser les plans de coupe les plus adaptés à la reconnaissance des repères anatomiques. L'appareil utilisé était un transducteur à balayage linéaire d'une fréquence de 7,5 MHz. Des coupes anatomiques ont été effectuées dans les mêmes plans, permettant d'identifier des détails intéressants. S'il fut facile d'individualiser tel ou tel repère anatomique en rapport avec les groupes ganglionnaires explorés, il fut par contre impossible de visualiser des noeuds normaux. La reconnaissance d'adénopathies ne semble donc possible que si les plans d'exploration sont strictement définis, et si l'examinateur est entrainé à l'identification topographique des différentes structures. En proposant un protocole d'exploration standardisé et en précisant certains repères anatomiques, le travail présenté ici se propose d'éviter quelques erreurs d'inter-prétation et d'augmenter la fiabilité de l'examen échographique. Les auteurs espèrent que ce protocole méthodique, économe en pertes de temps, facilitera le diagnostic d'adénopathies d'origine mammaire.
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Moriggl, B., Steinlechner, M. Ultrasono-anatomy for evaluation of the local lymphatic groups of the mamma. Surg Radiol Anat 16, 77–85 (1994). https://doi.org/10.1007/BF01627925
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DOI: https://doi.org/10.1007/BF01627925