Detection of internal mammary lymph node enlargement: comparison of CT scans and conventional roentgenograms

Internal thoracic lymphadenopathy and pulmonary tuberculosis

OBJECTIVE

Internal thoracic lymphadenopathy (ITL) has been associated with malignancies and non-tuberculous empyema. However, the association between ITL and active pulmonary tuberculosis (PTB) and the correlation between ITL and other imaging characteristics of active PTB has not been examined.

MATERIALS AND METHODS

A retrospective cohort study comprising 137 adults with active PTB who had a concomitant chest CT over a seven-year period was conducted. Two thoracic radiologists evaluated for ITL as well as nine other imaging characteristics of active tuberculosis, including total lung involvement (as measured by a total severity score), number of nodules, presence of tree-in-bud nodularity, highest extent of tree-in-bud nodularity in a lobe, miliary pattern, cavitary lesions, pleural effusion, lymphadenopathy (excluding internal thoracic lymph nodes), and empyema. The Wilcoxon rank-sum test and chi-squared tests were used to assess the correlation between ITL and additional imaging findings.

RESULTS

Internal thoracic lymphadenopathy was present in 50 of 137 cases (36.5%); most commonly bilateral (19.0%) or isolated on the right side (13.7%), and less commonly isolated on the left side (3.7%). Pleural effusion, lymphadenopathy (apart from internal thoracic compartment), and empyema all showed statistically significant correlations with ITL (p-values of <0.0001).

CONCLUSIONS

While the presence of ITL - particularly when accompanied by other imaging findings such as pleural effusion - may prompt a radiologist to first consider malignancy, active PTB should be an additional consideration in the appropriate clinical context.

Internal mammary lymph node recurrence: rare but characteristic metastasis site in breast cancer

Background

To assess the frequency of IMLN recurrence, its associated risk factors with disease-free interval (DFI) and its predicting factors on overall survival time.

Methods

133 cases of breast cancer IMLN recurrence were identified via the computerized CT reporting system between February 2003 and June 2008, during which chest CT for patients with breast cancer (n = 8867) were performed consecutively at Cancer Hospital, Fudan University, Shanghai, China. Patients' charts were retrieved and patients' characteristics, disease characteristics, and treatments after recurrence were collected for analysis. The frequency was 1.5% (133/8867).

Results

IMLN recurrence was presented as the first metastatic site in 121 (91%) patients while 88 (66.2%) had other concurrent metastases. Typical chest CT images included swelling of the IMLN at the ipsilateral side with local lump and sternal erosion located mostly between the second and third intercostal space. The median disease-free interval (DFI) of IMLN recurrence was 38 months. The independent factors that could delay the IMLN recurrence were small tumor size (HR 0.5 95%CI: 0.4 - 0.8; p = 0.002), and positive ER/PR disease (HR 0.6, 95% CI: 0.4 - 0.9; p = 0.006). The median survival time after IMLN recurrence was 42 months, with a 5-year survival rate of 30%. Univariate analysis showed four variables significantly influenced the survival time: DFI of IMLN recurrence (p = 0.001), no concurrent distant metastasis (p = 0.024), endocrine therapy for patients with positive ER/PR (p = 0.000), radiotherapy (p = 0.040). The independent factors that reduced the death risk were no concurrent distant metastases (HR: 0.7, 95% CI: 0.4 - 0.9; p = 0.031), endocrine therapy for patients with positive ER/PR status (HR: 0.2, 95% CI: 0.1 - 0.5; p = 0.001) and palliative radiotherapy (HR: 0.3, 95% CI: 0.1- 0.9; p = 0.026).

Conclusions

The risk of IMLN recurrence is low and there are certain characteristics features on CT images. ER/PR status is both a risk factor for DFI of IMLN recurrence and a prognostic factor for overall survival after IMLN recurrence. Patients with only IMLN recurrence and/or local lesion have a good prognosis.

Dynamic helical CT of breast tumors

PURPOSE

The purpose of our study was to test dynamic helical CT (hCT) in the evaluation of breast tumors.

METHOD

Thirty-six patients with 39 suspected lesions underwent breast hCT before and 1, 3, and 8 min after intravenous contrast medium administration. A marked enhancement (> or = 100%) at 1 or 3 min without increase at 8 minutes was considered as the primary indicator for malignancy. Twenty carcinomas, one metastatic non-Hodgkin lymphoma, six fibroadenomas, and six other benign findings were histologically assessed. Six cases had negative fine needle aspiration cytology and at least a 2 year negative follow-up.

RESULTS

hCT showed a 100% sensitivity and 83.3% specificity. Considering carcinomas and fibroadenomas, significant differences were found for the percent enhancement at 1 min (p = 0.002) as well as for the density increase or decrease at 3 versus 1 min (p = 0.0035), at 8 versus 1 min (p = 0.0027), and at 8 versus 3 min (p = 0.0180).

CONCLUSION

hCT proved to have a high diagnostic efficacy in evaluating breast tumors. Even though it involves some exposure to radiation, it should be considered in patients in whom MR is contraindicated.