Basak Erguvan Dogan MD, Presenter: Nothing to Disclose

Mark Joseph Dryden MD, Abstract Co-Author: Nothing to Disclose

Wei Wei, Abstract Co-Author: Nothing to Disclose

Bruno D. Fornage MD, Abstract Co-Author: Nothing to Disclose

Thomas A. Buchholz MD, Abstract Co-Author: Nothing to Disclose

Benjamin David Smith MD, Abstract Co-Author: Nothing to Disclose

Kelly K. Hunt MD, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Researcher, Hologic, Inc

To identify sensitivity, specificity and positive and negative predictive values of internal mammary (IM) ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) in the diagnosis of clinically occult metastatic IM nodes (IM-LAP).

The study included 595 consecutive patients with a newly diagnosed, intact breast cancer who underwent mammographic and breast US evaluation in our institution between September 1, 2011 and April 1, 2012. In all patients, US examination included survey of axillary (Ax), infraclavicular (Ic), IM, and supraclavicular (Sc) nodal basins. Patient demographics, cancer histopathological type, biological subtype and grade, size, location (medial, lateral, or central) and presence or absence of metastatic Ax, Ic, or Sc nodes were recorded. Fisher’s exact test and Wilcoxon rank test were used for statistical analysis.

58/595 (10%) patients had abnormal IM nodes on US. Patients with IM-LAP were younger than those without IM-LAP (mean, 46.8 years versus 55.8 years [p<0.0001]). Of these 58 patients, 8 (13.8%) had isolated IM-LAP, while 50 (86.2%) had metastatic nodes in other nodal basins. 29 (50%) of the 58 patients with metastatic-appearing IM nodes underwent US-guided FNAB, which confirmed malignancy in 26 (93%) patients and benign lymphoid tissue in 3 patients. The presence of metastatic IM nodes was associated with tumors of triple-negative type (p<0.0001), higher grade (p<0001), located in the medial breast (p<0.0001), measuring ≥5 cm (p<0.001), and with the existence of other (Ax, Ic, or Sc) metastatic nodes (p<0.0001). 23/29 (79%) biopsies were performed in patients who had Stage I and Stage II cancer pre-IM FNAB. Of the 537 IM US (-) patients, 3 (0.6%) underwent an IM sentinel node biopsy, which revealed a metastasis in 1 patient (0.2%).

In our series, 10% of patients with newly diagnosed breast cancer had suspicious ipsilateral IM nodes on IMUS, with 1.2% of these patients having isolated IM-LAP. Younger patients with ER-HER- cancers and medial tumors are more likely to have clinically occult IM node involvement. A negative IMUS excludes IM-LAP with a high level of confidence.

IMUS and FNA may have staging and treatment implications for baseline breast cancer staging in young patients with medially located ER-HER2- breast cancer.

Dogan, B, Dryden, M, Wei, W, Fornage, B, Buchholz, T, Smith, B, Hunt, K, Yang, W, Value of US and US-guided Needle Biopsy of Internal Mammary (IM) Nodal Basin in Baseline Staging of Breast Cancer Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009840.html