Radiology, Vol 167, 89-91, Copyright © 1988 by Radiological Society of North America
Internal mammary lymphadenopathy in breast carcinoma: CT appraisal of anatomic distribution
JC Scatarige, EK Fishman, ES Zinreich, RF Brem and R Almaraz
Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore.
Internal mammary lymph nodes are an important site of occult metastasis in
clinically operable and recurrent breast carcinoma. Anatomic distribution
of enlarged internal mammary nodes in patients with breast cancer was
analyzed in a review of thoracic computed tomographic studies of 219 women
with operable, advanced, or recurrent cancer. Enlarged nodes were observed
in 45 patients (20.5%), 32 with unilateral and 13 with bilateral
involvement. Mean nodal diameter was 1.95 cm (0.6- 6.0 cm). Lymphadenopathy
was limited to one anterior intercostal space in 43%, two spaces in 26%,
three spaces in 22%, and four spaces in 9%. Solitary or dominant nodal
enlargement was centered at the first space in 14%, second space in 60%,
and third space in 26%. Isolated lymphadenopathy in the fourth or fifth
spaces was not observed. Metastases to internal mammary nodes frequently
occur at multiple levels and are most common in the second and third
spaces. This finding concurs with current surgical practice when internal
mammary nodes are sampled.
