Learning objectives
- To assess the imaging appearance of internal mammary lymph nodes (IMLN) involvement in patients with breast cancer.
- To review the role of different imaging modalities in their study.
- To describe the radiological pitfalls that can mimic metastatic spread to this territory.
-To define an imaging algorithm to improve the accuracy of IMLN staging.
Background
Breast cancer is the second leading cause of cancer death in women,
exceeded only by lung cancer.Evaluation of tumor biologic features represents an evolving area ofgreatinterest in treatment and is becoming increasingly important.
However,the short term survival rate is largely dependent on the disease stage.
The role of imaging in breast cancer staging has evolved rapidly over the past few years,
and radiologic findings are now incorporated into clinical staging.
Anatomy
Theinternal mammary lymph nodes(IMLN),
also known as internal thoracic lymph nodes andparasternal nodes,are situated...
Findings and procedure details
A retrospective database search in a single institution from September 2015 to September 2017 identified seventy-six patients with breast cancer and IMLN involvement.
Forty-four patients (58%) were diagnosed of breast cancer metastatic dissemination or recurrence,
and thirty-two patients (42%) showed other pathologies (second primary nodal metastases,
infection/nonspecific inflammation and granulomatous silicone lymphadenitis).
US and PET-TC were useful to differentiate between inflammatory and metastatic lymphadenopathy in selected patients. Fig. 11
Conclusion
Accurate staging of IMLN is of upmost importance to assess the pathologic stage,
prognosis and adjuvant treatment modalities of patients with breast cancer.
Lymphadenopathies in this territory can be related to non-metastatic diseases.
The radiologist’s knowledge and the imaging appearance facilitates an accurate differential diagnosis with benign processes such as siliconomas.
References
A.R.Cahoon,
MD; B.D.Smith,
MD; W.
T.
Yang,
MBBS.
Internal Thoracic Lymphadenopathy in Breast Cancer.
RadioGraphics 2017; 37:1024-1036.
Volume 37 Number 4.
M.
Mack;A.Chetlen; J.
Liao.
Incidental Internal Mammary Lymph Nodes Visualized on Screening Breast MRI.
AJR 2015; 205:209-214.
July 2015.
S.C.
Lee,
MD; P.A.
Jain,
MD; S.C.
Jethwa,
DO; D.Tripathy,
MD; M.W.
Yamashita,
MD.
Radiologists' Role in Breast Cancer Staging: Providing Key Information for Clinicians.
RadioGraphics 2014; 34:330-342.
Volume 34 Number 2.
C.
I.
Caskey,
MD; W.
A.
Berg,
MD,
PhD; U.M.
Hamper,
MD; S.Sheth,...