Characterizing Axillary Web Syndrome: Ultrasonographic Efficacy

Abstract

The aim of this study was to determineif ultrasound could successfully characterizeaxillary web syndrome (AWS) and clarify thepathophysiologic basis of AWS as a vascularor lymphatic abnormality, or an abnormaltissue structure. This prospective studyevaluated women who developed AWSfollowing breast cancer surgery. Using an18MHz ultrasound transducer, images weretaken of the AWS cord and compared tomirror images on the contralateral side. Ablinded radiologist assessed the ultrasoundcharacteristics of and structural changes inthe skin and subcutaneous tissue andformulated an opinion as to the side in whichAWS was located. Seventeen subjectsparticipated in the study. No structure orabnormality consistent with AWS could beidentified by ultrasound. There were nostatistical differences between the ipsilateraland contralateral side in skin thickness;subcutaneous reflector thickness, number ordisorganization; or subcutaneous tissueechodensity (p>0.05). The radiologist correctlyidentified the side with AWS in 12 of 17subjects (=0.41). A distinct ultrasonographicstructure or abnormality could not beidentified in subjects with AWS using 18MHzultrasound. The inability to identify a specificstructure excludes the possibility that AWSis associated with vein thrombosis or a fascial abnormality, and supports the theory thatAWS may be pathology that is not visible with18MHz ultrasound, such as microlymphaticstasis or binding of fibrin or other proteins inthe interstitial space.