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. 2019 Sep;25(5):916-921.
doi: 10.1111/tbj.13355. Epub 2019 Jun 7.

MRI evaluation of axillary and intramammary lymph nodes in the postoperative period

Joao V Horvat  1 , Elizabeth A Morris  1 , Blanca Bernard-Davila  1 , Danny F Martinez  1 , Doris Leithner  1   2 , Rosa Elena Ochoa-Albiztegui  1 , Sunitha B Thakur  1   3 , Katja Pinker  1   4
Affiliations

MRI evaluation of axillary and intramammary lymph nodes in the postoperative period

Joao V Horvat et al. Breast J. 2019 Sep.

Abstract

Our study aimed to evaluate if breast-conserving surgery and adjuvant treatment could affect the morphological features of axillary and intramammary lymph nodes on magnetic resonance imaging (MRI) in patients with invasive breast cancer and clinically negative axilla. In this single-center study, we retrospectively evaluated 50 patients who had (a) breast-conserving surgery, (b) clinically negative axilla, (c) preoperative MRI within 3 months before surgery, and (d) postoperative MRI within 12 months after surgery. Axillary and intramammary lymph nodes on postoperative MRI were identified and then compared with preoperative MRI by two breast radiologists with regards to the following: enlargement, cortical thickening, presence of fatty hilum, irregularity, heterogeneity, matting, and axillary lymph node asymmetry. Three hundred and two axillary and eight intramammary lymph nodes were evaluated. Enlargement and cortical thickening were seen in 5/50 (10%) patients in three axillary and two intramammary lymph nodes. None of the lymph nodes on postoperative MRI demonstrated occurrence of lack of fatty hilum, irregularity, heterogeneity, matting or axillary lymph node asymmetry. No evidence of recurrence was observed on 2-year follow-up. Lymph node enlargement and cortical thickening may be observed in a few patients in the postoperative period. Nevertheless, in patients with clinically negative axilla, these changes in morphology are often related to treatment rather than malignancy and favor short-term follow-up as an alternative to lymph node biopsy.

Keywords: breast neoplasms; lymph nodes; magnetic resonance imaging; postoperative period; recurrence.

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Figures

Figure 1
Figure 1
Change in morphology of LNs: T1‐weighted contrast enhanced images showing a 53‐y‐old woman with an axillary LN with lack of fatty hilum on preoperative MRI (A) with reduction in size on postoperative MRI (B, arrows)
Figure 2
Figure 2
Change in morphology of LNs: T1‐weighted contrast enhanced images showing a 45‐y‐old woman with a small axillary LN on preoperative MRI (A) with enlargement on postoperative MRI (B, arrowheads)
Figure 3
Figure 3
Change in morphology of LNs: 48‐y‐old woman with a normal appearing intramammary LN on preoperative T1‐weighted contrast enhanced image (A), presenting with enlargement on postoperative MRI (B). Follow‐up MRI (C) 2 y later showed that the LN returned to its preoperative dimensions
See this image and copyright information in PMC

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