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.
Highlights
Nodal status in breast cancer is one of the determining factors for staging, treatment, and prognosis
There are studies that demonstrate that preoperative imaging of lymph node (LN) is still necessary, some authors believe that the importance of preopera‐ tive evaluation of LNs has been diminished.[4,5,6,7]
Enlargement and cortical thickening of LNs were observed in 10% of patients and were not related to malignancy in our series as no signs of recurrence were observed at 2‐year follow‐up
Summary
Nodal status in breast cancer is one of the determining factors for staging, treatment, and prognosis. In the last two decades, sentinel LN biopsy has become the method of choice for selecting patients with negative LNs in whom axillary LN dissection can be avoided, reducing the incidence of postsurgical complications.[1] More recently, the American College of Surgeons Oncology Group Z0011 study demonstrated that axillary LN dissection can be avoided in patients with 1‐2 positive LNs on sentinel LN biopsy if they meet certain criteria.[2,3] there are studies that demonstrate that preoperative imaging of LNs is still necessary, some authors believe that the importance of preopera‐ tive evaluation of LNs has been diminished.[4,5,6,7] While these advances impact nodal staging in the preoperative setting, there is a need to advance the assessment of LNs fol‐ lowing breast‐conserving surgery to determine the possibility of re‐ currence. The aim of this study was to evaluate if breast‐ conserving surgery and adjuvant treatment affect the morphological features of axillary and intramammary LNs on MRI in patients with invasive breast cancers and negative axillae
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