title: Detection of Internal Mammary Adenopathy in Patients With Breast Cancer by PET/CT and MRI.
abstract: OBJECTIVE
  The purpose of this study was to assess the prevalence of internal mammary node (IMN) adenopathy in patients with breast cancer and compare breast MRI and PET/CT for detection of IMN adenopathy.
  
  
  METHODS
  This retrospective study included 90 women who underwent MRI and PET/CT before neoadjuvant chemotherapy for clinical stage IIA through IIIA disease. MRI and PET/CT examinations were read independently by two readers trained in breast imaging and nuclear medicine. All patients underwent follow-up MRI at the end of chemotherapy, and 10 with hypermetabolic IMNs underwent follow-up PET/CT. Histology was not obtained. Women were considered to have IMN adenopathy when nodes seen on MRI or having standardized uptake value (SUV) greater than mediastinal blood pool decreased in either size or SUV (or both) after treatment. Features including lymphovascular invasion, tumor quadrant(s), and axillary adenopathy were compared between presence and absence of IMN adenopathy using Fisher's exact test. Prevalence was determined on the basis of the percentage of patients with IMN adenopathy by either modality. The McNemar test compared the prevalence of IMN adenopathy on MRI to its prevalence on PET/CT.
  
  
  RESULTS
  Prevalence of IMN adenopathy was 16% (14/90) by MRI and 14% (13/90) by PET/CT (p = 0.317). After chemotherapy, IMN adenopathy resolved in 12 of 14 patients (86%). In two patients with poor responses in primary tumors, IMN adenopathy persisted, and both patients developed metastatic disease within 6 months. At 3 years, survival was significantly worse in patients with IMN adenopathy than in those without (85.7% vs 53.3%, respectively; p = 0.009).
  
  
  CONCLUSIONS
  In women with advanced breast cancer receiving neoadjuvant chemo-therapy, prevalence of IMN adenopathy was 16%, equally detected by breast MRI and PET/CT. Identification of IMN adenopathy may affect treatment and provides prognostic information.
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Maxine S
authors.initials: MS
authors.lastname: Jochelson
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Lizza
authors.initials: L
authors.lastname: Lebron
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Stefanie S
authors.initials: SS
authors.lastname: Jacobs
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Virgilio
authors.initials: V
authors.lastname: Sacchini
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ulaner
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.affiliation: 1 All authors: Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: D David
authors.initials: DD
authors.lastname: Dershaw
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA
keywords: PET/CT; breast MRI; breast cancer; internal mammary nodes; neoadjuvant chemotherapy