Internal mammary lymph nodes as incidental findings at screening breast MRI



      To evaluate the prevalence of internal mammary lymph nodes (IMLNs) on breast magnetic resonance imaging (MRI) in a screening population.

      Materials and methods

      We retrospectively reviewed 92 consecutive screening breast MRI exams. Logistic regression was performed to ascertain the risk of IMLNs in cancer-free subjects and to determine whether the risk varies with age.


      IMLNs were present in 48.9% of patients. Mean node size was 4 mm (range, 3–10 mm). The prevalence of IMLNs was not related to age. No patients developed breast cancer after a mean follow-up of 3 years.


      Subcentimeter IMLNs are common incidental findings at screening breast MRI.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cody HS
        • Urban JA
        Internal mammary node status: a major prognosticator in axillary node-negative breast cancer.
        Ann Surg Oncol. 1995; 2: 32-37
        • Sugg SL
        • Ferguson DJ
        • Posner MC
        • Heimann R
        Should internal mammary nodes be sampled in the sentinel lymph node era?.
        Ann Surg Oncol. 2000; 7: 188-192
        • Veronesi U
        • Cascinelli N
        • Greco M
        • Bufalino R
        • Morabito A
        • Galluzzo D
        • et al.
        Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes.
        Ann Surg. 1985; 202: 702-707
        • Darby SC
        • McGale P
        • Taylor CW
        • Peto R
        Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries.
        Lancet Oncol. 2005; 6: 557-565
        • Kinoshita T
        • Odagiri K
        • Andoh K
        • Doiuchi T
        • Sugimura K
        • Shiotani S
        • et al.
        Evaluation of small internal mammary lymph metastases in breast cancer by MRI.
        Radiat Med. 1999; 17: 189-193
        • Veronesi U
        • Cascinelli N
        • Bufalino R
        • Morabito A
        • Greco M
        • Galluzzo D
        • et al.
        Risk of internal mammary lymph node metastasis and its relevance in prognosis of breast cancer patients.
        Ann Surg. 1983; 198: 681-684
        • Chen RC
        • Lin NU
        • Golshan M
        • Harris JR
        • Bellon JR
        Internal mammary nodes in breast cancer: diagnosis and implications for patient management—a systematic review.
        J Clin Oncol. 2008; 26: 4981-4989
        • Donegan WL
        The influence of untreated internal mammary metastases upon the course of mammary cancer.
        Cancer. 1977; 39: 533-538
        • Livingston SF
        • Arlen M
        The extended extrapleural radical mastectomy: its role in the treatment of carcinoma of the breast.
        Ann Surg. 1974; 179: 260-265
        • Lacour J
        • Bucalossi P
        • Cacers E
        • Jacobelli G
        • Koszarowski T
        • Le M
        • et al.
        Radical mastectomy versus radical mastectomy plus internal mammary dissection: five-year results of an international cooperative study.
        Cancer. 1976; 37: 206-214
        • Huang O
        • Wang L
        • Shen K
        • Lin H
        • Hu Z
        • Liu G
        • et al.
        Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2,269 Chinese breast cancer patients treated with extended radical mastectomy.
        Breast Cancer Res Treat. 2008; 107: 379-387
        • Lehman CD
        • DeMartini W
        • Anderson BO
        • Edge SB
        Indications for breast MRI in the patient with newly diagnosed breast cancer.
        J Natl Compr Canc Netw. 2009; 7: 193-201
        • Maneiro MB
        Regional lymph node staging in breast cancer: the increasing role of imaging and ultrasound-guided axillary lymph node fine needle aspiration.
        Radiol Clin N Am. 2010; 48: 989-997
        • Fornage BD
        • Dogan BE
        • Sneige N
        • Staerkel GA
        Ultrasound-guided fine-needle aspiration biopsy of internal mammary nodes: technique and preliminary results in breast cancer patients.
        AJR. 2014; 203: W213-W220
        • Madsen E
        • Gobardhan P
        • Bongers V
        • Albregts M
        • Burgmans J
        • De Hooge P
        • et al.
        The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer.
        Ann Surg Oncol. 2007; 14: 1486-1492
        • Leidenius MHK
        • Krogerus LA
        • Toivonen TS
        • Leppänen EA
        • von Smitten KA
        The clinical value of parasternal sentinel node biopsy in breast cancer.
        Ann Surg Oncol. 2006; 13: 321-326
        • Farrús B
        • Vidal-Sicart S
        • Velasco M
        • Zanón G
        • Fernández P
        • Muñoz M
        • et al.
        Incidence of internal mammary node metastases after a sentinel lymph node technique in breast cancer and its implication in the radiotherapy plan.
        Int J Radiat Oncol Biol Phys. 2004; 60: 715-721
        • Estourgie SH
        • Tanis PJ
        • Nieweg OE
        • Valdés Olmos RA
        • Rutgers EJ
        • Kroon BB
        Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients.
        Ann Surg Oncol. 2003; 10: 935-941
        • Wang CL
        • Eissa MJ
        • Roger JV
        • Aravkin AY
        • Porter BA
        • Beatty JD
        18F-FDG PET/CT-positive internal mammary lymph nodes: pathologic correlation by ultrasound-guided fine-needle aspiration and assessment of associated risk factors.
        AJR. 2013; 200: 1138-1144
        • Heuts EM
        • van der Ent FWC
        • von Meyenfeldt MF
        • Voogd AC
        Internal mammary lymph drainage and sentinel node biopsy in breast cancer—a study on 1008 patients.
        Eur J Surg Oncol. 2009; 35: 252-257