Incidental Internal Mammary Lymph Nodes Visualized on Screening Breast MRI

Mack, Meghan; Chetlen, Alison L.; Liao, Jason

doi:10.2214/ajr.14.13586

Cited by 23 publications

(16 citation statements)

References 28 publications

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“…In the present study, the short axis length was considerably shorter than that of axillary LN and the long axis length was slightly shorter than that of axillary LN. In recent studies of normal internal mammary lymph nodes incidentally detected on breast MRI, the average long axis diameter was 4.5 mm (range, 2–9 mm) [ 12 ] or 4 mm (range, 3–10 mm) [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer

Lee

Kim

2016

J Breast Cancer

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PurposeThe purpose of this study was to assess magnetic resonance imaging (MRI) features of malignant internal mammary lymph nodes (IMLNs) and benign IMLNs in breast cancer patients.MethodsFrom 2009 to 2014, the records of 85 patients with IMLNs were archived using MRI report data; 26 patients with small size (long axis diameter <5 mm) nodes were subsequently excluded. The current study evaluated internal mammary lymph nodes in 59 patients who underwent breast MRI for breast cancer staging and for posttherapy follow-up. All MRI findings were retrospectively evaluated. Malignancy was determined based on pathologic examination and positron emission tomography computed tomography findings. Independent t-tests, Mann-Whitney U tests, chi-square tests, and receiver operating characteristics (ROC) curve analysis were used.ResultsAmong MRI features, there were statistically significant differences between benign and malignant IMLN groups, in short axis length (3.6±1.3 vs. 8.2±2.9 mm, respectively), long axis length (8.1±2.4 vs. 14.5±4.8 mm, respectively), short/long axis ratio (0.45±0.10 vs. 0.59±0.17, respectively), absent fatty hilum (mean, 0% vs. 95%, respectively), and restricted diffusion (15.8% vs. 85.0%, respectively) (p<0.050). Multiplicity and location of intercostal spaces was not different between the two groups. Short axis length was the most discriminative variable for predicting metastatic nodes (area under the ROC curve, 0.951; threshold, 4 mm; sensitivity, 92.5%; specificity, 84.2%).ConclusionConventional MRI and diffusion-weighted MRI are helpful to detect metastasis of internal mammary lymph nodes in breast cancer.

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Section: Discussionmentioning

confidence: 99%

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer

Lee

Kim

2016

J Breast Cancer

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“…Similarly, in a study where IMN metastasis was determined based on pathologic evaluation or PET-CT finding, IMN short-axis length ≥ 0.4 cm was predictive of positive metastasis with 92.5% sensitivity and 84.2% specificity [14]. According to recent studies of physiologic IMN adenopathy incidentally found in healthy females undergoing screening breast MRI, the mean IMN diameter was 0.45 cm [16] or 0.4 cm [17]. Based on above-mentioned studies, we defined IMN ≥ 0.5 cm on imaging studies as clinically positive for metastasis in our study.…”

Section: Discussionmentioning

confidence: 98%

Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

et al. 2020

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Background: This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer. Methods: We retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician's discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0-63.5 Gy) and high-dose IMN RT (63.6-70.4 Gy). Results: After a median follow-up of 58 months (range, 12-111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019). Conclusions: IMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.

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“…Then, the center points of IM-SLNs were transferred from the SPECT/CT fusion images onto corresponding anatomical positions of the representative CT images. Previous studies have indicated that the average size of the IM-SLNs was 5 mm (17)(18)(19). All imaging IM-SLNs were plotted with a diameter of 5 mm, and named IM-SLN 5mm.…”

Section: Im-sln Delineationmentioning

confidence: 99%

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

Wang

et al. 2020

Front. Oncol.

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Purpose: Mapping the distribution of internal mammary sentinel lymph nodes (IM-SLNs) presented on single photon emission computed tomography in conjunction with computed tomography (SPECT/CT) images to explore the value of IM-SLN to guide tailored clinical target volume (CTV) delineation of postoperative prophylactic IMNI. Materials and methods: Ninety-seven patients who underwent preoperative lymphoscintigraphy by SPECT/CT and had imaging of IM-SLN were selected in this study. The imaging IM-SLNs on SPECT/CT of eligible patients were projected onto corresponding anatomical positions of a representative axial CT image. The IMN CTVs were delineated on the representative axial CT images according to the Radiation Therapy Oncology Group (RTOG) and Danish Breast Cancer Cooperative Group (DBCG) guideline, and defined as CTV RTOG and CTV DBCG. The location of the IM-SLNs was compared with the RTOG and DBCG guidelines of IMN target volume delineations, respectively. The intercostal space distribution of IM-SLNs was recorded. The distances from the CTV RTOG and CTV DBCG to the IM-SLNs were measured, respectively. Results: The total number of imaging IM-SLNs was 136. IM-SLNs were mostly found in the first intercostal space (40.4%), with 30.2, 24.3, 4.4, and 0.7% of IM-SLNs in the second, third, fourth, and fifth intercostal space, respectively. The average distance from the edge of the CTV RTOG and the edge of CTV DBCG to the central points of the IM-SLNs was 4.10 mm (SD, 3.3 mm) and 1.60 mm (SD, 2.6 mm), respectively (t = 16.640, P = 0.000). The average distance from the edge of CTV RTOG and the edge of CTV DBCG to the lateral border IM-SLN was 6.40 mm (SD, 3.5 mm) and 3.34 mm (SD, 3.3 mm), respectively (t = 19.815, P = 0.000). Only 18.4% of IM-SLN central points were included in the CTV RTOG , and 60.3% of IM-SLN central points were included in the CTV DBCG. When covering 90 and 100% of the IM-SLN center points, the CTV RTOG needs to expand 8 and 15 mm, respectively, and the CTV DBCG needs to expand 5 and 13 mm, respectively.

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Incidental Internal Mammary Lymph Nodes Visualized on Screening Breast MRI

Abstract: In this small cohort, 1-3 presumed normal internal mammary lymph nodes measuring 2-9 mm (mean diameter 4.5 mm) were detected in about half of asymptomatic high-risk women presenting for screening MRI of the breasts.

Cited by 23 publications

References 28 publications

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer

Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

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