Mack Meghan, Chetlen Alison, Liao Jason
1 Penn State College of Medicine, 500 University Dr, Hershey, PA 17033.
2 Department of Radiology, Penn State Milton S. Hershey Medical Center, Penn State Hershey Breast Imaging, Hershey, PA.
AJR Am J Roentgenol. 2015 Jul;205(1):209-14. doi: 10.2214/AJR.14.13586.
The frequency of visualization and size of internal mammary lymph nodes in women undergoing high-risk screening breast MRI is unknown. When these nodes are discovered on staging MRI of newly diagnosed breast cancer patients, management could present a treatment dilemma because normal size criteria do not exist. The aim of this study was to establish the average size and frequency of internal mammary lymph nodes observed in asymptomatic high-risk women undergoing screening breast MRI.
We conducted a retrospective review of 108 women at high risk for breast cancer who underwent screening breast MRI between January 2010 and January 2014. Patients with new or previous diagnosis of breast cancer, prior nonbreast malignancy affecting the thorax or mediastinum, or previous radiation to the thorax were excluded. The presence, diameter, laterality, intercostal space, relationship to the internal mammary vessels, age, morphology, and clinical history of internal mammary lymph nodes were recorded.
Internal mammary lymph nodes were visualized in 50 of 108 high-risk patients, with an average size of 4.5 mm (range [± SD], 2-9 ± 1.59 mm). In the 50 women who had internal mammary lymph nodes visible on MRI, an average of 1.4 nodes (range, 1-3 nodes) were present. Internal mammary lymph nodes were more frequently visualized on the left (p < 0.001), at the second and third intercostal spaces (p = 0.007), and medial to the internal mammary vessels (p < 0.001).
In this small cohort, 1-3 presumed normal internal mammary lymph nodes measuring 2-9 mm (mean diameter 4.5 mm) were detected in about half of asymptomatic high-risk women presenting for screening MRI of the breasts.
接受高风险筛查乳腺MRI检查的女性，其乳内淋巴结的可视化频率及大小尚不清楚。当在新诊断乳腺癌患者的分期MRI上发现这些淋巴结时，由于不存在正常大小标准，治疗管理可能会面临两难困境。本研究的目的是确定在接受乳腺MRI筛查的无症状高风险女性中观察到的乳内淋巴结的平均大小和频率。
我们对2010年1月至2014年1月期间接受乳腺MRI筛查的108例乳腺癌高风险女性进行了回顾性研究。排除有新诊断或既往诊断乳腺癌、既往影响胸部或纵隔的非乳腺恶性肿瘤或既往胸部放疗史的患者。记录乳内淋巴结的存在情况、直径、侧别、肋间间隙、与乳内血管的关系、年龄、形态及临床病史。
108例高风险患者中有50例可见乳内淋巴结，平均大小为4.5mm（范围[±标准差]，2 - 9±1.59mm）。在MRI上可见乳内淋巴结的50例女性中，平均有1.4个淋巴结（范围，1 - 3个淋巴结）。乳内淋巴结在左侧更常见（p < 0.001），在第二和第三肋间间隙更常见（p = 0.007），且位于乳内血管内侧（p < 0.001）。
在这个小队列中，约一半接受乳腺筛查MRI的无症状高风险女性检测到1 - 3个推测正常的乳内淋巴结，大小为2 - 9mm（平均直径4.5mm）。
