J Breast Cancer.  2016 Jun;19(2):191-198. 10.4048/jbc.2016.19.2.191.

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

• Lee HW
• Kim SH

• KMID: 2308971
• DOI: http://doi.org/10.4048/jbc.2016.19.2.191

Abstract

PURPOSE
The 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.
METHODS
From 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.
RESULTS
Among 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%).
CONCLUSION
Conventional MRI and diffusion-weighted MRI are helpful to detect metastasis of internal mammary lymph nodes in breast cancer.

Keyword

Breast neoplasms; Lymph nodes; Magnetic resonance imaging; Neoplasm metastasis

MeSH Terms

Breast Neoplasms*
Breast*
Diffusion
Follow-Up Studies
Humans
Lymph Nodes*
Magnetic Resonance Imaging*
Neoplasm Metastasis
Positron-Emission Tomography
Retrospective Studies
ROC Curve
Sensitivity and Specificity

Figure

• 

  Figure 1 A 41-year-old woman with invasive ductal carcinoma in the left breast and malignant lymph node confirmed by core needle biopsy. (A) Axial fat suppressed contrast enhanced T1-weighted image reveals an internal mammary lymph node in the first intercostal space with short axis of 15 mm, long axis of 17 mm and loss of fatty hilum. (B) Diffusion weighted imaging shows a high-signal-intensity of lymph node (arrow). (C) Apparent diffusion coefficient map shows a low-signal-intensity (arrow). (D) Positron emission tomography computed tomography reveals presence of focal fluorodeoxyglucose uptake in the same location of left internal mammary lymph node with a maximum standardized uptake value of 5.6 (arrow).

• 

  Figure 2 A 48-year-old woman with invasive ductal carcinoma in the left breast and malignant lymph node classified due to increased fluorodeoxyglucose (FDG) uptake on positron emission tomography computed tomography (PET/CT). (A) Axial fat suppressed T1-weighted image reveals an internal mammary lymph node (arrow) in the third intercostal space with loss of fatty hilum. (B) Axial fat suppressed contrast enhanced T1-weighted image, the size of lymph node is short axis of 9 mm and long axis of 15 mm. (C) Diffusion weighted imaging shows a high-signal-intensity of lymph node (arrow). (D) Apparent diffusion coefficient map shows a low-signal-intensity (arrow). (E) Initial PET/CT reveals presence of focal FDG uptake in the same location of left internal mammary lymph node with a maximum standardized uptake value of 1.5 (arrow). (F) Four months later, there is a marked increased FDG uptake from 1.5 to 7.8 (arrow).

• 

  Figure 3 A 41-year-old woman with invasive ductal carcinoma in the left breast and benign lymph node confirmed by fine-needle aspiration and biopsy. (A) Axial fat suppressed T1-weighted image reveals an internal mammary lymph node (arrowheads) in the second intercostal space with preserved fatty hilum showing low-signal-intensity (arrow). (B) On axial fat suppressed contrast enhanced T1-weighted image, the size of lymph node is 4 mm (short axis) and 12 mm (long axis). (C) Diffusion weighted imaging shows a high-signal-intensity of lymph node (arrow). (D) Apparent diffusion coefficient map shows a iso-signal-intensity (arrow).

• 

  Figure 4 A 53-year-old woman with invasive ductal carcinoma in the left breast and benign lymph node (LN) classified due to no fluorodeoxyglucose (FDG) uptake on positron emission tomography computed tomography (PET/CT). (A) Axial fat suppressed contrast enhanced T1-weighted image reveals an internal mammary LN in the second intercostal space with short axis of 3 mm, long axis of 7 mm and preserved fatty hilum. (B) Diffusion weighted imaging shows a high-signal-intensity of LN (arrow). (C) Apparent diffusion coefficient map shows a low-signal-intensity (arrow). Initial (D) and after 1 year and 1 month (E) PET/CT reveals absence of focal FDG uptake in the same location of left internal mammary LN (arrow).

• 

  Figure 5 Receiver operating characteristic curves for the individual evaluated magnetic resonance imaging parameters of the internal mammary lymph node. The area under the receiver operating characteristics curve of short axis length, long axis length and short axis length/long axis length (S/L) ratio were 0.951, 0.906, and 0.756, respectively.

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