Incidence of internal mammary lymph nodes with silicone breast implants at MR imaging after oncoplastic surgery Journal Article


Authors: Sutton, E. J.; Watson, E. J.; Gibbons, G.; Goldman, D. A.; Moskowitz, C. S.; Jochelson, M. S.; Dershaw, D. D.; Morris, E. A.
Article Title: Incidence of internal mammary lymph nodes with silicone breast implants at MR imaging after oncoplastic surgery
Abstract: Purpose: To assess the incidence of benign and malignant internal mammary lymph nodes (IMLNs) at magnetic resonance (MR) imaging among women with a history of treated breast cancer and silicone implant reconstruction. Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women were identified who (a) had breast cancer, (b) underwent silicone implant oncoplastic surgery, and (c) underwent postoperative implant-protocol MR imaging with or without positron emission tomography (PET)/computed tomography (CT) between 2000 and 2013. The largest IMLNs were measured. A benign IMLN was pathologically proven or defined as showing 1 year of imaging stability and/or no clinical evidence of disease. Malignant IMLNs were pathologically proven. Incidence of IMLN and positive predictive value (PPV) were calculated on a perpatient level by using proportions and exact 95% confidence intervals (CIs). The Wilcoxon rank sum test was used to assess the difference in axis size. Results: In total, 923 women with breast cancer and silicone implants were included (median age, 46 years; range, 22-89 years). The median time between reconstructive surgery and first MR imaging examination was 49 months (range, 5-513 months). Of the 923 women, 347 (37.6%) had IMLNs at MR imaging. Median short-and long-axis measurements were 0.40 cm (range, 0.20-1.70 cm) and 0.70 cm (range, 0.30-1.90 cm), respectively. Two hundred seven of 923 patients (22.4%) had adequate follow-up; only one of the 207 IMLNs was malignant, with a PPV of 0.005 (95% CI: 0.000, 0.027). Fifty-eight of 923 patients (6.3%) had undergone PET/CT; of these, 39 (67.2%) had IMLN at MR imaging. Twelve of the 58 patients (20.7%) with adequate follow-up had fluorine 18 fluorodeoxyglucose- avid IMLN, with a median standardized uptake value of 2.30 (range, 1.20-6.10). Only one of the 12 of the fluorodeoxyglucose-avid IMLNs was malignant, with a PPV of 0.083 (95% CI: 0.002, 0.385). Conclusion: IMLNs identified at implant-protocol breast MR imaging after oncoplastic surgery for breast cancer are overwhelmingly more likely to be benign than malignant. Imaging follow-up instead of immediate metastatic work-up may be warranted. © 2015 RSNA.
Keywords: adult; aged; cancer surgery; major clinical study; plastic surgery; postoperative care; nuclear magnetic resonance imaging; follow up; lymph node metastasis; breast cancer; retrospective study; lymph node; partial mastectomy; fluorodeoxyglucose f 18; computer assisted emission tomography; breast surgery; predictive value; pet scanner; nuclear magnetic resonance scanner; radiological procedures; very elderly; silicone breast implant; human; female; priority journal; article; internal mammary lymph node
Journal Title: Radiology
Volume: 277
Issue: 2
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2015-11-01
Start Page: 381
End Page: 387
Language: English
DOI: 10.1148/radiol.2015142717
PROVIDER: scopus
PUBMED: 26098457
PMCID: PMC4976465
DOI/URL:
Notes: Export Date: 2 December 2015 -- Source: Scopus
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MSK Authors
  1. D David Dershaw
    176 Dershaw
  2. Elizabeth A Morris
    247 Morris
  3. Chaya S. Moskowitz
    173 Moskowitz
  4. Debra Alyssa Goldman
    94 Goldman
  5. Elizabeth Jane Sutton
    26 Sutton
  6. Elizabeth   Watson
    3 Watson