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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(02): 197-204
DOI: 10.1055/s-0042-1750180
Original Article

Management of MRI-Detected Benign Internal Mammary Lymph Nodes

Gozde Gunes 
1   Department of Radiology, Baskent University Hospital, Çankaya/Ankara, Turkey
,
Priscila Crivellaro
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
,
Derek Muradali
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations Funding No funding.
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Abstract

Introduction In this retrospective study, we aimed to evaluate benign internal mammary lymph nodes (IMLNs) in terms of frequency, number, size, long axis/short axis (L/S) ratio, intercostal location, presence of fatty hilum, and stability using breast magnetic resonance imaging (MRI) and discuss the findings by reviewing existing literature.

Methods This single-center study consisted of 130 women between the ages of 24 and 76 years, who had at least two breast MRI examinations in our institution, with the latest exam performed between January 1, 2019 and November 1, 2019, were eligible for the study. MRIs of the study group were independently reviewed by two radiologists.

Results IMLN was detected in 31.1% of the 427 MRIs, with a total number of 256 nodes. The most common indication for breast MRI was high-risk screening (66.2%). The median number of nodes per patient was 1 (range: 1–6). The median follow-up time was 19.5 months (range: 6–141 months). None of these benign nodes showed significant interval growth. Mean L/R ratio of the nodes was 1.9. One hundred and four nodes (n = 104, 40.6%) had a L/S ratio less than 2 and 43.2% (n = 45) of the nodes with a L/S ratio less than 2, had a long axis measuring less than or equal to 3mm. IMLN of patients with breast implants had the largest mean long axis. The fatty hilum was identified in 34.3% (n = 68) of the 256 nodes. The size of the lymph nodes where fatty hilum was visualized was significantly larger than the ones where fatty hilum was not visualized (p < 0.001). Fatty hilum could be visualized in only 2.7% of the nodes with a long axis smaller than 3 mm.

Conclusion IMLN is a frequent finding on breast MRI. We have shown that benign IMLNs might be large sized in specific cases like patients with breast implants. When small sized (≤3mm), they are more likely to be rounded (L/S ratio <2). The fatty hilum that is a feature of benignity might not be visualized in nodes less than or equal to3mm.

Keywords

screening - internal mammary lymph node - MRI - breast cancer - high risk


Publication History

Article published online:
13 July 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Alduk AM, Prutki M, Stern-Padovan R. Incidental extra-mammary findings in breast MRI. Clin Radiol 2015; 70 (05) 523-527
    CrossrefPubMedGoogle Scholar
  • 2 Nelson HD, Zakher B, Cantor A. et al. Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Ann Intern Med 2012; 156 (09) 635-648
    CrossrefPubMedGoogle Scholar
  • 3 Cancer Care Ontario (CCO) Information for Healthcare Providers on the Ontario Breast Screening Program (OBSP) [(accessed on 15 January 2019)];. Accessed May 12, 2022 online: https://archive.cancercare.on.ca/pcs/screening/breastscreening/OBSP/
  • 4 Smith RA, Saslow D, Sawyer KA. et al; American Cancer Society High-Risk Work Group; American Cancer Society Screening Older Women Work Group; American Cancer Society Mammography Work Group; American Cancer Society Physical Examination Work Group; American Cancer Society New Technologies Work Group; American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 2003; 53 (03) 141-169
    CrossrefPubMedGoogle Scholar
  • 5 Lee CH, Dershaw DD, Kopans D. et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010; 7 (01) 18-27
    CrossrefPubMedGoogle Scholar
  • 6 Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med 2008; 148 (09) 671-679
    CrossrefPubMedGoogle Scholar
  • 7 Mainiero MB, Cinelli CM, Koelliker SL, Graves TA, Chung MA. Axillary ultrasound and fine-needle aspiration in the preoperative evaluation of the breast cancer patient: an algorithm based on tumor size and lymph node appearance. AJR Am J Roentgenol 2010; 195 (05) 1261-1267
    CrossrefPubMedGoogle Scholar
  • 8 Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol 2001; 176 (04) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 9 Dogan BE, Dryden MJ, Wei W. et al. Sonography and sonographically guided needle biopsy of internal mammary nodes in staging of patients with breast cancer. AJR Am J Roentgenol 2015; 205 (04) 905-911
    CrossrefPubMedGoogle Scholar
  • 10 Veronesi U, Paganelli G, Viale G. et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006; 7 (12) 983-990
    CrossrefPubMedGoogle Scholar
  • 11 Gradishar WJ, Anderson BO, Balassanian R. et al. NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2016; 14 (03) 324-354
    PubMedGoogle Scholar
  • 12 Wernli KJ, DeMartini WB, Ichikawa L. et al; Breast Cancer Surveillance Consortium. Patterns of breast magnetic resonance imaging use in community practice. JAMA Intern Med 2014; 174 (01) 125-132
    CrossrefPubMedGoogle Scholar
  • 13 Grabau D, Jensen MB, Rank F, Blichert-Toft M. Axillary lymph node micrometastases in invasive breast cancer: national figures on incidence and overall survival. APMIS 2007; 115 (07) 828-837
    CrossrefPubMedGoogle Scholar
  • 14 Sivridis E, Giatromanolaki A, Galazios G, Koukourakis MI. Node-related factors and survival in node-positive breast carcinomas. Breast 2006; 15 (03) 382-389
    CrossrefPubMedGoogle Scholar
  • 15 Woo CS, Silberman H, Nakamura SK. et al. Lymph node status combined with lymphovascular invasion creates a more powerful tool for predicting outcome in patients with invasive breast cancer. Am J Surg 2002; 184 (04) 337-340
    CrossrefPubMedGoogle Scholar
  • 16 Mack M, Chetlen A, Liao J. Incidental internal mammary lymph nodes visualized on screening breast MRI. AJR Am J Roentgenol 2015; 205 (01) 209-214
    CrossrefPubMedGoogle Scholar
  • 17 Sachdev S, Goodman CR, Neuschler E. et al. Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer. Radiat Oncol 2017; 12 (01) 199
    CrossrefPubMedGoogle Scholar
  • 18 Wang Y, Qi W, Xu H. et al. Infiltration tendency of internal mammary lymph nodes involvement in patients with breast cancer: anatomical characteristics and implications for target delineation. Radiat Oncol 2019; 14 (01) 208
    CrossrefPubMedGoogle Scholar
  • 19 Ying M, Ahuja AT, Evans R, King W, Metreweli C. Cervical lymphadenopathy: sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas. J Clin Ultrasound 1998; 26 (08) 383-389
    CrossrefPubMedGoogle Scholar
  • 20 Sugama Y, Kitamura S. Ultrasonographic evaluation of neck and supraclavicular lymph nodes metastasized from lung cancer. Intern Med 1992; 31 (02) 160-164
    CrossrefPubMedGoogle Scholar
  • 21 Yao ZH, Wu AR. [Supraclavicular lymph node metastasis from carcinoma of the uterine cervix after radiotherapy–analysis of 219 patients]. Zhonghua Zhong Liu Za Zhi 1988; 10 (03) 230-232
    PubMedGoogle Scholar
  • 22 Choi YJ, Ko EY, Han BK, Shin JH, Kang SS, Hahn SY. High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast 2009; 18 (02) 119-122
    CrossrefPubMedGoogle Scholar
  • 23 Sutton EJ, Watson EJ, Gibbons G. et al. Incidence of internal mammary lymph nodes with silicone breast implants at MR imaging after oncoplastic surgery. Radiology 2015; 277 (02) 381-387
    CrossrefPubMedGoogle Scholar
  • 24 Zambacos GJ, Molnar C, Mandrekas AD. Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts. Aesthetic Plast Surg 2013; 37 (02) 278-289
    CrossrefPubMedGoogle Scholar
  • 25 Ray KM, Munir R, Wisner DJ. et al. Internal mammary lymph nodes as incidental findings at screening breast MRI. Clin Imaging 2015; 39 (05) 791-793
    CrossrefPubMedGoogle Scholar
  • 26 Savaridas SL, Spratt JD, Cox J. Incidence and potential significance of internal mammary lymphadenopathy on computed tomography in patients with a diagnosis of primary breast cancer. Breast Cancer (Auckl) 2015; 9: 59-65
    Google Scholar
  • 27 Lee HW, Kim SH. Breast magnetic resonance imaging for assessment of internal mammary lymph node status in breast cancer. J Breast Cancer 2016; 19 (02) 191-198
    CrossrefPubMedGoogle Scholar
  • 28 Stomper PC, Leibowich S, Meyer JE. The prevalence and distribution of well circumscribed nodules on screening mammography: analysis of 1500 mammograms. Breast Dis 1991; 4: 197-203
    Google Scholar
  • 29 Abdullgaffar B, Gopal P, Abdulrahim M, Ghazi E, Mohamed E. The significance of intramammary lymph nodes in breast cancer: a systematic review and meta-analysis. Int J Surg Pathol 2012; 20 (06) 555-563
    CrossrefPubMedGoogle Scholar