Jose Maria Oliver-Goldaracena, Presenter: Nothing to Disclose

Vicenta Córdoba Chicote, Abstract Co-Author: Nothing to Disclose

Juan Pablo Garcia Fresnadillo MD, Abstract Co-Author: Nothing to Disclose

Rodriguez Hugo, Abstract Co-Author: Nothing to Disclose

Sara Moron Hodge MD, PhD, Abstract Co-Author: Nothing to Disclose

Agustin Andres, Abstract Co-Author: Nothing to Disclose

Laura Cadenas MD, Abstract Co-Author: Nothing to Disclose

To evaluate the usefulness of adding internal mammary ultrasound (US) to ipsilateral axillary US in the nodal staging of invasive breast cancer.

Patients with invasive breast cancer or suspicious lesions are routinely studied with ipsilateral axilla and internal mammary US at our institution. A retrospective study was made of 361 consecutive patients with proven invasive breast cancer who underwent this practice between May 2009 and January 2011. Suspicious lymph nodes detected at internal mammary chain sonography were studied with a cross sectional technique (CT or MR). When CT or MRI proved these lymph nodes they were considered metastasic. US guided fine needle aspiration (FNA) or PET/CT was performed to confirm it. If an axillary suspicious lymph node was detected US guided FNA was done.

US detected lymph nodes with suspicious findings in the internal mammary chain in 10 patients. Sectional imaging techniques confirmed 9 of them (8 by MR and 1 by CT). All these patients showed metastasic findings, positive FNA (2), positive FNA and PET-CT (1) and PET-CT (6). US detected associated axillary nodal involvement that was confirmed with FNA in 7 patients. Metastasis to ipsilateral internal mammary chain changed nodal status from N0 to N2 in 2 patients (T1,T2), N1 to N3 in 4 patients [T1 (1), T2 (3)] and from N2 to N3 in 3 patients (T2,T3,T4) . Staging group was modified in 5 patients, from SI to SIII (1) and from SII to SIII (4). Treatment approach was adjusted in 4 of these patients who therefore received preoperative chemotherapy. Supplemental internal mammary chain irradiation was performed in 6 patients.         

Our study suggests that US is useful in detecting internal mammary lymph node metastasis, despite it’s low detection rate, 2,5% of patients.This finding modified disease stage and treatment approach in almost half of these patients.

Adding internal mammary ultrasound to ipsilateral axillary ultrasound improves regional lymph node staging in patients with invasive breast cancer. 

Oliver-Goldaracena, J, Córdoba Chicote, V, Garcia Fresnadillo, J, Hugo, R, Moron Hodge, S, Andres, A, Cadenas, L, Internal Mammary Chain Ultrasound for Nodal Staging of Breast Invasive Carcinoma: A Worthwhile Procedure.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003617.html