Internal mammary node adenopathy on breast MRI and PET/CT for initial staging in patients with operable breast cancer: prevalence and associated factors
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To evaluate the prevalence of and factors associated with internal mammary node (IMN) adenopathy on MRI and PET/CT used for initial staging in patients with operable breast cancer.
A total of 1320 patients diagnosed with invasive breast carcinoma between January 2011 and December 2015 underwent MRI and PET/CT for initial staging. The patients were considered to have IMN adenopathy when MRI revealed IMNs with the longest diameter of 5 mm or greater and a standardized uptake value greater than that of the mediastinal blood pool/contralateral parasternal area on PET/CT. The prevalence was determined as overall percentage of patients with IMN adenopathy, as well as percentages among patients who received neoadjuvant chemotherapy and those who did not. The association of IMN adenopathy with factors was evaluated using multivariate logistic regression analysis.
Of the 1320 patients, 35 patients [2.7 %; 95 % confidence interval (CI) 1.8–3.6 %] had IMN adenopathy, with a total of 49 IMNs. Among patients without and with neoadjuvant chemotherapy (n = 1092 and n = 228, respectively), IMN adenopathy was identified in 13 (1.2 %; 95 % CI 0.6–2.0 %) and 22 patients (9.6 %; 95 % CI 6.0–14.6 %), respectively. Inner tumor location [odds ratio (OR) 5.9; P = .002] and positive axillary lymph node status (OR 4.4; P < .0001) were associated with IMN adenopathy.
IMN adenopathy was identified at initial staging with PET/CT and MRI with a prevalence of 2.7 %. Inner tumor location and positive axillary lymph node status were associated with IMN adenopathy.
KeywordsInvasive breast cancer Breast MRI PET–CT Internal mammary node IMN adenopathy
This work was supported by Biomedical Research Institute Grant, Kyungpook National University Hospital (2016).
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark G, Edge SB, Hayes DF, Hughes LL, Hutter RV, Morrow M, Page DL, Recht A, Theriault RL, Thor A, Weaver DL, Wieand HS, Greene FL (2002) Revision of the American joint committee on cancer staging system for breast cancer. J Clin Oncol 20(17):3628–3636CrossRefPubMedGoogle Scholar
- 2.Veronesi U, Arnone P, Veronesi P, Galimberti V, Luini A, Rotmensz N, Botteri E, Ivaldi GB, Leonardi MC, Viale G, Sagona A, Paganelli G, Panzeri R, Orecchia R (2008) The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series. Ann Oncol 19(9):1553–1560. doi: 10.1093/annonc/mdn183 CrossRefPubMedGoogle Scholar
- 3.Stemmer SM, Rizel S, Hardan I, Adamo A, Neumann A, Goffman J, Brenner HJ, Pfeffer MR (2003) The role of irradiation of the internal mammary lymph nodes in high-risk stage II to IIIA breast cancer patients after high-dose chemotherapy: a prospective sequential nonrandomized study. J Clin Oncol 21(14):2713–2718. doi: 10.1200/JCO.2003.09.096 CrossRefPubMedGoogle Scholar
- 4.Thorsen LB, Offersen BV, Dano H, Berg M, Jensen I, Pedersen AN, Zimmermann SJ, Brodersen HJ, Overgaard M, Overgaard J (2015) DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol. doi: 10.1200/JCO.2015.63.6456 PubMedGoogle Scholar
- 5.Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M, De Winter K, Marnitz S, Barillot I, Scandolaro L, Vonk E, Rodenhuis C, Marsiglia H, Weidner N, van Tienhoven G, Glanzmann C, Kuten A, Arriagada R, Bartelink H, Van den Bogaert W, Oncology ER, Breast Cancer G (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373(4):317–327. doi: 10.1056/NEJMoa1415369 CrossRefPubMedGoogle Scholar
- 7.Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, Correa C, Cutter D, Gagliardi G, Gigante B, Jensen MB, Nisbet A, Peto R, Rahimi K, Taylor C, Hall P (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998. doi: 10.1056/NEJMoa1209825 CrossRefPubMedGoogle Scholar
- 9.Carcoforo P, Sortini D, Feggi L, Feo CV, Soliani G, Panareo S, Corcione S, Querzoli P, Maravegias K, Lanzara S, Liboni A (2006) Clinical and therapeutic importance of sentinel node biopsy of the internal mammary chain in patients with breast cancer: a single-center study with long-term follow-up. Ann Surg Oncol 13(10):1338–1343. doi: 10.1245/s10434-006-9062-4 CrossRefPubMedGoogle Scholar
- 10.Madsen E, Gobardhan P, Bongers V, Albregts M, Burgmans J, De Hooge P, Van Gorp J, van Dalen T (2007) The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 14(4):1486–1492. doi: 10.1245/s10434-006-9230-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Plana MN, Carreira C, Muriel A, Chiva M, Abraira V, Emparanza JI, Bonfill X, Zamora J (2012) Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol 22(1):26–38. doi: 10.1007/s00330-011-2238-8 CrossRefPubMedGoogle Scholar
- 15.Aukema TS, Straver ME, Peeters MJ, Russell NS, Gilhuijs KG, Vogel WV, Rutgers EJ, Olmos RA (2010) Detection of extra-axillary lymph node involvement with FDG PET/CT in patients with stage II-III breast cancer. Eur J Cancer 46(18):3205–3210. doi: 10.1016/j.ejca.2010.07.034 CrossRefPubMedGoogle Scholar
- 17.Jochelson MS, Lebron L, Jacobs SS, Zheng J, Moskowitz CS, Powell SN, Sacchini V, Ulaner GA, Morris EA, Dershaw DD (2015) Detection of internal mammary adenopathy in patients with breast cancer by PET/CT and MRI. AJR Am J Roentgenol 205(4):899–904. doi: 10.2214/AJR.14.13804 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.An YY, Kim SH, Kang BJ, Lee AW (2015) Comparisons of positron emission tomography/computed tomography and ultrasound imaging for detection of internal mammary lymph node metastases in patients with breast cancer and pathologic correlation by ultrasound-guided biopsy procedures. J Ultrasound Med 34(8):1385–1394. doi: 10.7863/ultra.34.8.1385 CrossRefPubMedGoogle Scholar
- 20.Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JM, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, Paik S, Perez EA, Press MF, Spears PA, Vance GH, Viale G, Hayes DF, American Society of Clinical O, College of American P (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: american society of clinical oncology/college of American pathologists clinical practice guideline update. J Clin Oncol 31(31):3997–4013. doi: 10.1200/JCO.2013.50.9984 CrossRefPubMedGoogle Scholar
- 23.Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Kobrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46(8):1296–1316. doi: 10.1016/j.ejca.2010.02.015 CrossRefPubMedGoogle Scholar
- 26.Wang CL, Eissa MJ, Rogers JV, Aravkin AY, Porter BA, Beatty JD (2013) 18F-FDG PET/CT-positive internal mammary lymph nodes: pathologic correlation by ultrasound-guided fine-needle aspiration and assessment of associated risk factors. AJR Am J Roentgenol 200(5):1138–1144. doi: 10.2214/AJR.12.8754 CrossRefPubMedGoogle Scholar
- 27.Huang O, Wang L, Shen K, Lin H, Hu Z, Liu G, Wu J, Lu J, Shao Z, Han Q, Shen Z (2008) Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2269 Chinese breast cancer patients treated with extended radical mastectomy. Breast Cancer Res Treat 107(3):379–387. doi: 10.1007/s10549-007-9561-4 CrossRefPubMedGoogle Scholar
- 28.Eubank WB, Mankoff DA, Takasugi J, Vesselle H, Eary JF, Shanley TJ, Gralow JR, Charlop A, Ellis GK, Lindsley KL, Austin-Seymour MM, Funkhouser CP, Livingston RB (2001) 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 19(15):3516–3523PubMedGoogle Scholar