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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
Internal thoracic, parasternal nodes
Definitions
Enlarged, abnormal node(s) in internal mammary region
Physiologic internal mammary nodes (IMN) in 46% (50/108, Mack) and 49% (45/92, Ray) of screening MR
Mean size: 4.5 mm (range: 2-10 mm), 1-3 nodes
71% (48/68) visible on left side; 29% (20/68) on right; 11/15 with multiple IMN had bilateral
IMAGING
General Features
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Staging, Grading, & Classification
CLINICAL ISSUES
Natural History & Prognosis
Treatment
Selected References
Boekel NB et al: Cardiovascular disease incidence after internal mammary chain irradiation and anthracycline-based chemotherapy for breast cancer. Br J Cancer. ePub, 2018
Joo JH et al: Evaluation of the prognostic stage in the 8th Edition of the American Joint Committee on Cancer in Patients with Breast Cancer and Internal Mammary Lymph Node Metastasis. Anticancer Res. 38(9):5357-5361, 2018
Wang K et al: Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients: Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT). Medicine (Baltimore). 97(28):e11296, 2018
Cahoon AR et al: Internal Thoracic Lymphadenopathy in Breast Cancer. Radiographics. 37(4):1024-1036, 2017
Jeong CJ et al: Metastatic internal mammary lymph nodes or mimickers on parasternal ultrasonography: focusing on their distribution and depth. Acta Radiol. 284185117702180, 2017
Nikolaevich NS et al: Why do we need irradiation of internal mammary lymph nodes in patients with breast cancer: Analysis of lymph flow and radiotherapy studies. Rep Pract Oncol Radiother. 22(1):37-41, 2017
Tan C et al: Is Sentinel node biopsy of the internal mammary lymph nodes relevant in the management of breast cancer? Breast J. ePub, 2017
Asadi M et al: Internal mammary sentinel lymph node biopsy in clinical practice. Int J Surg. 36(Pt A):332-334, 2016
Lee HW et al: Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer. J Breast Cancer. 19(2):191-8, 2016
Zhou ZR et al: Is internal mammary nodes irradiation as a part of breast cancer postoperative radiotherapy necessary? J Thorac Dis. 8(11):3427-3430, 2016
Dogan BE et al: Sonography and sonographically guided needle biopsy of internal mammary nodes in staging of patients with breast cancer. AJR Am J Roentgenol. 205(4):905-11, 2015
Jochelson MS et al: Detection of internal mammary adenopathy in patients with breast cancer by PET/CT and MRI. AJR Am J Roentgenol. 205(4):899-904, 2015
Mack M et al: Incidental internal mammary lymph nodes visualized on screening breast MRI. AJR Am J Roentgenol. 205(1):209-14, 2015
Madsen EV et al: Prognostic Significance of Tumor-Positive Internal Mammary Sentinel Lymph Nodes in Breast Cancer: A Multicenter Cohort Study. Ann Surg Oncol. 22(13):4254-62, 2015
Ray KM et al: Internal mammary lymph nodes as incidental findings at screening breast MRI. Clin Imaging. 39(5):791-3, 2015
Sutton EJ et al: Incidence of internal mammary lymph nodes with silicone breast implants at MR imaging after oncoplastic surgery. Radiology. 277(2):381-7, 2015
Fornage BD: Local and regional staging of invasive breast cancer with sonography: 25 years of practice at MD Anderson Cancer Center. Oncologist. 19(1):5-15, 2014
Fornage BD et al: Ultrasound-guided fine-needle aspiration biopsy of internal mammary nodes: technique and preliminary results in breast cancer patients. AJR Am J Roentgenol. 203(2):W213-20, 2014
Groheux D et al: 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging. J Nucl Med. 54(1):5-11, 2013
Wang CL et al: (18)F-FDG PET/CT-positive internal mammary lymph nodes: pathologic correlation by ultrasound-guided fine-needle aspiration and assessment of associated risk factors. AJR Am J Roentgenol. 200(5):1138-44, 2013
Hindié E et al: Lymphoscintigraphy can select breast cancer patients for internal mammary chain radiotherapy. Int J Radiat Oncol Biol Phys. 83(4):1081-8, 2012
Kong AL et al: Impact of internal mammary lymph node drainage identified by preoperative lymphoscintigraphy on outcomes in patients with stage I to III breast cancer. Cancer. 118(24):6287-96, 2012
Koolen BB et al: Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy. Breast Cancer Res Treat. 135(1):231-40, 2012
Segaert I et al: Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 16(6):617-24, 2010
Domènech-Vilardell A et al: Removal of the internal mammary sentinel node in breast cancer. Nucl Med Commun. 30(12):962-70, 2009
Spillane AJ et al: Axillary Staging and Sentinel Nodes. The anatomically correct incidence of internal mammary node drainage on lymphoscintigraphy. Cancer Research. 69(2): Supplement 1, 2009
Chen RC et al: Internal mammary nodes in breast cancer: diagnosis and implications for patient management -- a systematic review. J Clin Oncol. 26(30):4981-9, 2008
Groheux D et al: Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer. Int J Radiat Oncol Biol Phys. 71(3):695-704, 2008
Yao MS et al: Internal mammary nodal chain drainage is a prognostic indicator in axillary node-positive breast cancer. Ann Surg Oncol. 14(10):2985-93, 2007
Benda RK et al: Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification? Cancer. 100(3):518-23, 2004
Shimazu K et al: Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer. Ann Surg. 237(3):390-8, 2003
Eubank WB et al: 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol. 19(15):3516-23, 2001
Freedman GM et al: Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys. 46(4):805-14, 2000
Sugg SL et al: Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol. 7(3):188-92, 2000
Cody HS 3rd et al: Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol. 2(1):32-7, 1995
Scatarige JC et al: Internal mammary lymphadenopathy: imaging of a vital lymphatic pathway in breast cancer. Radiographics. 10(5):857-70, 1990
Veronesi U et al: Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg. 198(6):681-4, 1983
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
Internal thoracic, parasternal nodes
Definitions
Enlarged, abnormal node(s) in internal mammary region
Physiologic internal mammary nodes (IMN) in 46% (50/108, Mack) and 49% (45/92, Ray) of screening MR
Mean size: 4.5 mm (range: 2-10 mm), 1-3 nodes
71% (48/68) visible on left side; 29% (20/68) on right; 11/15 with multiple IMN had bilateral
IMAGING
General Features
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Staging, Grading, & Classification
CLINICAL ISSUES
Natural History & Prognosis
Treatment
Selected References
Boekel NB et al: Cardiovascular disease incidence after internal mammary chain irradiation and anthracycline-based chemotherapy for breast cancer. Br J Cancer. ePub, 2018
Joo JH et al: Evaluation of the prognostic stage in the 8th Edition of the American Joint Committee on Cancer in Patients with Breast Cancer and Internal Mammary Lymph Node Metastasis. Anticancer Res. 38(9):5357-5361, 2018
Wang K et al: Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients: Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT). Medicine (Baltimore). 97(28):e11296, 2018
Cahoon AR et al: Internal Thoracic Lymphadenopathy in Breast Cancer. Radiographics. 37(4):1024-1036, 2017
Jeong CJ et al: Metastatic internal mammary lymph nodes or mimickers on parasternal ultrasonography: focusing on their distribution and depth. Acta Radiol. 284185117702180, 2017
Nikolaevich NS et al: Why do we need irradiation of internal mammary lymph nodes in patients with breast cancer: Analysis of lymph flow and radiotherapy studies. Rep Pract Oncol Radiother. 22(1):37-41, 2017
Tan C et al: Is Sentinel node biopsy of the internal mammary lymph nodes relevant in the management of breast cancer? Breast J. ePub, 2017
Asadi M et al: Internal mammary sentinel lymph node biopsy in clinical practice. Int J Surg. 36(Pt A):332-334, 2016
Lee HW et al: Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer. J Breast Cancer. 19(2):191-8, 2016
Zhou ZR et al: Is internal mammary nodes irradiation as a part of breast cancer postoperative radiotherapy necessary? J Thorac Dis. 8(11):3427-3430, 2016
Dogan BE et al: Sonography and sonographically guided needle biopsy of internal mammary nodes in staging of patients with breast cancer. AJR Am J Roentgenol. 205(4):905-11, 2015
Jochelson MS et al: Detection of internal mammary adenopathy in patients with breast cancer by PET/CT and MRI. AJR Am J Roentgenol. 205(4):899-904, 2015
Mack M et al: Incidental internal mammary lymph nodes visualized on screening breast MRI. AJR Am J Roentgenol. 205(1):209-14, 2015
Madsen EV et al: Prognostic Significance of Tumor-Positive Internal Mammary Sentinel Lymph Nodes in Breast Cancer: A Multicenter Cohort Study. Ann Surg Oncol. 22(13):4254-62, 2015
Ray KM et al: Internal mammary lymph nodes as incidental findings at screening breast MRI. Clin Imaging. 39(5):791-3, 2015
Sutton EJ et al: Incidence of internal mammary lymph nodes with silicone breast implants at MR imaging after oncoplastic surgery. Radiology. 277(2):381-7, 2015
Fornage BD: Local and regional staging of invasive breast cancer with sonography: 25 years of practice at MD Anderson Cancer Center. Oncologist. 19(1):5-15, 2014
Fornage BD et al: Ultrasound-guided fine-needle aspiration biopsy of internal mammary nodes: technique and preliminary results in breast cancer patients. AJR Am J Roentgenol. 203(2):W213-20, 2014
Groheux D et al: 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging. J Nucl Med. 54(1):5-11, 2013
Wang CL et al: (18)F-FDG PET/CT-positive internal mammary lymph nodes: pathologic correlation by ultrasound-guided fine-needle aspiration and assessment of associated risk factors. AJR Am J Roentgenol. 200(5):1138-44, 2013
Hindié E et al: Lymphoscintigraphy can select breast cancer patients for internal mammary chain radiotherapy. Int J Radiat Oncol Biol Phys. 83(4):1081-8, 2012
Kong AL et al: Impact of internal mammary lymph node drainage identified by preoperative lymphoscintigraphy on outcomes in patients with stage I to III breast cancer. Cancer. 118(24):6287-96, 2012
Koolen BB et al: Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy. Breast Cancer Res Treat. 135(1):231-40, 2012
Segaert I et al: Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 16(6):617-24, 2010
Domènech-Vilardell A et al: Removal of the internal mammary sentinel node in breast cancer. Nucl Med Commun. 30(12):962-70, 2009
Spillane AJ et al: Axillary Staging and Sentinel Nodes. The anatomically correct incidence of internal mammary node drainage on lymphoscintigraphy. Cancer Research. 69(2): Supplement 1, 2009
Chen RC et al: Internal mammary nodes in breast cancer: diagnosis and implications for patient management -- a systematic review. J Clin Oncol. 26(30):4981-9, 2008
Groheux D et al: Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer. Int J Radiat Oncol Biol Phys. 71(3):695-704, 2008
Yao MS et al: Internal mammary nodal chain drainage is a prognostic indicator in axillary node-positive breast cancer. Ann Surg Oncol. 14(10):2985-93, 2007
Benda RK et al: Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification? Cancer. 100(3):518-23, 2004
Shimazu K et al: Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer. Ann Surg. 237(3):390-8, 2003
Eubank WB et al: 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol. 19(15):3516-23, 2001
Freedman GM et al: Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys. 46(4):805-14, 2000
Sugg SL et al: Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol. 7(3):188-92, 2000
Cody HS 3rd et al: Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol. 2(1):32-7, 1995
Scatarige JC et al: Internal mammary lymphadenopathy: imaging of a vital lymphatic pathway in breast cancer. Radiographics. 10(5):857-70, 1990
Veronesi U et al: Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg. 198(6):681-4, 1983
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