RSNA 2008 

Abstract Archives of the RSNA, 2008


LL-CH4198-L03

Incidence and Significance of Internal Mammary Lymph Nodes in Patients after Mastectomy with Breast Expander Reconstructive Surgery

Scientific Posters

Presented on December 3, 2008
Presented as part of LL-CH-L: Chest 

Participants

Rathachai Kaewlai MD, Presenter: Nothing to Disclose
Subba Rao Digumarthy MD, Abstract Co-Author: Nothing to Disclose
Jo-Anne O'Malley Shepard MD, Abstract Co-Author: Nothing to Disclose
Barbara L. Smith MD, PhD, Abstract Co-Author: Nothing to Disclose
William G Austen MD, Abstract Co-Author: Nothing to Disclose
Amita Sharma MBBS, Abstract Co-Author: Nothing to Disclose

PURPOSE

To study the incidence and significance of new internal mammary lymphadenopathy in patients after mastectomy and breast reconstruction with saline breast expanders.

METHOD AND MATERIALS

A query of radiology database yielded 429 patients with breast prostheses who had CT/MRI exams over a 4-year period. Medical records were reviewed for types and indications for surgery. Exclusion criteria were patients without CT/MRI before and within 6 months after surgery, multiple surgeries and non-expander breast implants. Two thoracic radiologists independently evaluated for presence and size of internal mammary lymph nodes on chest/breast CT/MRI. Comparison of internal mammary nodes was done on the sides with and without surgery. Statistical significance calculated with Fisher Exact and student t-tests.

RESULTS

50 breasts in 25 women (age 50.7 years, SD 8.4, range 37-69) were selected. One breast was excluded for multiple surgeries. Total of 39 mastectomies were done with breast expander placements for 26 breast cancers, 1 phylloides tumor, 1 fibrocystic disease and 11 normal breasts. No surgical procedures were performed on 10 breasts. Incidence of internal mammary lymph nodes was 79.5% (31/39) on the side of surgery; and 30% (3/10) on the other side (p < 0.001). The average size of internal mammary lymph nodes on the side of surgery was 7.2 x 4.2 mm (range 2-15). On the side without surgery, the average lymph node size was 3.7 x 3.3 mm (range 3-5). The difference was statistically significant (p < 0.05). No significant difference in the size and incidence of lymphadenopathy with regard to the presence of breast cancer was noted. Follow-up scans beyond 6 months were performed in 10 patients (mean 23.7 months, SD 10.1, range 8-38). The nodes decreased (8/13, 61.5%) or remained stable (4/13, 26.7%). A case of increased lymph node was found to be reactive after surgery (1/13, 7.7%). None of the patients had clinical recurrence of breast cancer with average clinical follow up of 25.1 months (SD ± 16.1, range 4-50).

CONCLUSION

Internal mammary lymphadenopathy is commonly seen after mastectomy and saline breast expanders in the first 6 months. These nodes decrease or remain stable on follow-ups and are likely benign.

CLINICAL RELEVANCE/APPLICATION

Internal mammary lymph nodes are commonly seen among women who have had saline breast expanders inserted following mastectomy. Most of these are reactive and decrease/remain stable on follow up.

Cite This Abstract

Kaewlai, R, Digumarthy, S, Shepard, J, Smith, B, Austen, W, Sharma, A, Incidence and Significance of Internal Mammary Lymph Nodes in Patients after Mastectomy with Breast Expander Reconstructive Surgery.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012754.html