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Internal mammary lymph node metastases in breast cancer: what should radiologists know?

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The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces. IMLN metastasis, which forms a part of clinical TNM staging, may negatively affect the prognosis of primary breast cancer patients. IMLN metastasis is clinically detected using ultrasound, computed tomography, magnetic resonance imaging, and 18F-deoxyglucose positron emission tomography computed tomography. The uptake of radioactive tracers in IMLN with clinically negative axillary lymph nodes is often identified using sentinel lymph node mapping (SLNM) in primary breast cancer patients. The indication for IMLN biopsy or resection that is clinically detected or visualized using SLNM is controversial. The clinically suspicious IMLN may be considered for ultrasound-guided fine-needle aspiration. First IMLN recurrence needs to be biopsied. Irradiation of the breast, chest wall, and/or regional nodal irradiation, including IMLN, following lumpectomy or postmastectomy is recommended. Although radiation therapy for IMLN recurrence may improve clinical outcomes, it is also associated with pulmonary and cardiac toxicities. This review covers the local anatomy of IMLN, lymph drainage and image findings of IMLN with a discussion.

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This paper was presented in part at the 103rd annual meeting of the Radiological Society of North America (RSNA) in Chicago, 2017. It received a Certification of Merit for an education exhibit.

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Correspondence to Misugi Urano.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Urano, M., Denewar, F.A., Murai, T. et al. Internal mammary lymph node metastases in breast cancer: what should radiologists know?. Jpn J Radiol 36, 629–640 (2018).

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