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Axillary Lymph Node Biopsy

Axillary Lymph node (underarm gland) enlargement is a common problem among Indian women.

Patient usually present with complaints of pain in the armpit and/or lumps in the underarm area.

Majority of the times these lumps are reactive in nature, that means they enlarge due to non specific causes like mild hair follicle infection, which can occur after shaving or waxing of hair.

On the other hand, these glands can also become enlarged due to:

Infections like tuberculosis, which can be associated with weight loss & fever
Cancers – commonest cancer which gives rise to underarm nodes is breast cancer. Axillary lymph nodes are the first point of spread from breast cancer.

An ultrasound can confirm the diagnosis of axillary lymph node enlargement and if these glands do not resolve after a course of antibiotics, they require a FNAC (fine needle aspiration cytology or in simple terms a ‘needle test’).

If FNAC is inconclusive, then an axillary lymph node biopsy is required to confirm the diagnosis. Axillary lymph node biopsy is a minor procedure, which can be performed as a day care surgery.

Changes in 8th AJCC Classification of Breast Cancer

Recently, the eighth edition of the TNM classification of AJCC (American Joint Commission of Cancer) was released. This had a few notable changes from the 7th edition, which have been highlighted below:
Immunohistochemically detected tumor markers (ER, PR, HER 2 neu) that are known to have great practical treatment importance are now incorporated into the staging system to refine prognosis of breast cancer
The eighth edition of the staging system also uses genomic assays (Oncotype Dx, Mammaprint, PAM 50) when available to downstage some estrogen receptor-positive, lymph node-negative tumors.
Lobular carcinoma in situ is removed from the staging system because it is not a malignancy but a risk factor. It is no longer considered Tis.
The expert panel clarified that the postneoadjuvant therapy pathological T category (ypT) is based on the largest focus of residual tumor, if present. Treatment-related fibrosis adjacent to residual invasive carcinoma is not included in the ypT maximum dimension.