Is screening detected bilateral axillary adenopathy on mammography clinically significant?

Our objective was to retrospectively review the incidence and outcome of asymptomatic patients recalled from screening due to bilateral axillary adenopathy (BAxA) with an otherwise normal mammogram. This study included all women recalled from screening due to BAxA that underwent ultrasound guided biopsy between July 2004 and April 2010. Women with a known etiology for adenopathy were excluded. One radiologist blinded to biopsy outcome evaluated mammographic lymph node characteristics. Twelve of 74,926 screening mammograms (0.016%) performed during the study period met inclusion criteria. Five women (41.7%) had non-Hodgkin lymphoma (NHL); two had long axis dimension of <20 mm, but had prior mammograms demonstrating an increase in size and density of the lymph nodes. There were no significant differences in lymph node characteristics between benign and malignant results. This study finds a high positive predictive value for malignancy for BAxA when no etiology is apparent. We propose that patients with BAxA as the sole mammographic abnormality undergo further imaging and clinical evaluation as this may indicate significant pathology.