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. 2017 Dec 19;12(1):199.
doi: 10.1186/s13014-017-0934-5.

Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer

Sean Sachdev  1 , Chelain R Goodman  1 , Erin Neuschler  2 , Kapila Kalakota  3 , Daniel Cutright  1 , Eric D Donnelly  1 , John P Hayes  1 , Adam E Prescott  1 , Gianna Mirabelli  1 , Jonathan B Strauss  4
Affiliations

Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer

Sean Sachdev et al. Radiat Oncol. .

Abstract

Background: The internal mammary (IM) lymph node chain, along with the axillary nodal basin, is a first-echelon breast lymphatic draining site. A growing body of evidence supports irradiation of this region in node-positive breast cancer. This study evaluated the effectiveness of radiotherapy in treating magnetic resonance imaging (MRI)-detected abnormal IM lymph nodes in newly-diagnosed non-metastatic breast cancer.

Methods: A structured query was performed on an electronic institutional database to identify women with radiographic evidence of abnormal IM node(s) on breast MRI from 2005 to 2013. Manual review narrowed inclusion to patients with a primary diagnosis of non-metastatic breast cancer with abnormal IM node(s) based on pathologic size criteria and/or abnormal enhancement.

Results: Of the 7070 women who underwent pre-treatment MRI, 19 (0.3%) were identified on imaging to have a total of 25 abnormal pre-treatment IM lymph nodes, of which 96% were located in the first two intercostal spaces and 4% in the third space. A majority of the primary tumors were high-grade (94.7%) and hormone-receptor negative (73.7%), while 47.4% overexpressed HER-2/neu receptor. Axillary nodal disease was present in 89.5% of patients, while one patient had supraclavicular involvement. At a median follow-up of 38 months, 31.6% of patients had developed metastatic disease and 21.1% had died from their disease. Of the patients who received IM coverage, none had progressive disease within the IM lymph node chain.

Conclusions: Radiologic evidence of pre-treatment abnormal IM chain lymph nodes was associated with advanced stage, high grade, and negative estrogen receptor status. The majority of positive lymph nodes were located within the first two intercostal spaces, while none were below the third. Radiation of the IM chain in combination with modern systemic therapy was effective in achieving locoregional control without surgical resection in this cohort of patients.

Keywords: Breast; Breast neoplasms; Lymph nodes; Magnetic resonance imaging; Radiotherapy.

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Conflict of interest statement

Ethics approval and consent to participate

All data collection and analyses were performed after review by and approval of the institutional review board (IRB) and in accordance with medical research principles outlined by the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Intercostal space distribution of involved nodes. Schematic diagram of the intercostal space distribution of the 25 abnormal internal mammary lymph nodes identified on pre-treatment breast MRI
Fig. 2
Fig. 2
Representative MRI and treatment plan. Representative internal mammary node identified on MRI (Top) and treatment plan of dedicated 14Gy boost (Bottom). Maroon contour = IM node GTV
See this image and copyright information in PMC

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