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Introduction. Breast cancer (BC) is the most common oncological pathology in women in Russia (23 % in the structure of oncological diseases). About 90 % of deaths from this disease are caused by metastases. In this regard, it is critically important to effectively detect metastases in the regional lymphatic system at the stage of tumor development. The aim of the study is to develop and present stratified variants of metastatic lesion of regional lymph nodes in breast cancer based on a comprehensive analysis of echographic semiotics, which are significant for optimizing the diagnostic algorithm. Materials and methods. For the study, the results of a comprehensive examination of outpatient patients who applied for the first time and in dynamics to the Republican Oncological Dispensary in the period from August to November 2025 with a diagnosis of "malignant neoplasm of the mammary glands" were taken. The protocols of ultrasound examination of mammary glands, postoperative scars and regional lymph nodes were studied. Results. Metastatic lymph node damage was detected in 14 (13 %) patients, including three at the initial treatment, 11 during dynamic follow–up, and two after radical mastectomy. Based on the analysis of echographic signs (shape, contours, internal structure, and the nature of blood flow), six variants of changes in lymph nodes were identified and characterized, of which five correspond to a metastatic lesion. Discussion and conclusion. Due to the high incidence of breast cancer and polymophrism of echoscopic semiotics, any non-standard deviations in the structure of lymph nodes in women should be considered through the prism of the possibility of their metastatic lesion. Even if one of the criteria is present, it requires a comprehensive diagnosis and comparison with clinical data, mammography, and, above all, a biopsy (fine needle or trepanobiopsy). This contributes to the timely verification of breast cancer and the choice of rational treatment tactic.