![]() ![]() Diminished survival in patients with inner versus outer quadrant breast cancers. Tumor location of the lower-inner quadrant is associated with an impaired survival for women with early-stage breast cancer. Sarp S, Fioretta G, Verkooijen HM, et al. Lymphatic drainage patterns from the breast. Estourgie SH, Nieweg OE, Olmos RA, Rutgers EJ, Kroon BB. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Veronesi U, Cascinelli N, Greco M, et al. Incidental internal mammary lymph nodes visualized on screening breast MRI. Parasternal sonography of the internal mammary vessels: technique, normal anatomy, and lymphadenopathy. Scatarige JC, Hamper UM, Sheth S, Allen HA 3rd. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III, eds. Prognostic significance of tumor-positive internal mammary sentinel lymph nodes in breast cancer: a multicenter cohort study. Madsen EV, Aalders KC, van der Heiden-van der Loo M, et al. ![]() ![]() The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Use of lymphoscintigraphy defines lymphatic drainage patterns before sentinel lymph node biopsy for breast cancer. A succinct discussion of the clinical management of ITN-positive BC and its challenges is also included. The imaging appearance of pathologic ITNs using various modalities, potential mimics of IT adenopathy, and image-guided sampling techniques are described. In this article, the authors discuss current knowledge of the ITNs in BC and review ITN anatomy. Radiologists who image and diagnose BC can offer more accurate staging assessments by consistently evaluating the IT nodal chain in the BC patient. Since the initial ITN studies in the 1960s, improvement in imaging techniques and the availability of minimally invasive biopsy techniques have fueled renewed interest in ITNs and their clinical significance in BC. Despite the established prognostic significance of IT adenopathy in BC, this nodal basin is not routinely staged due to the difficulty in accessing it and due to the controversy regarding its management. It has been observed that medial tumors carry a worse prognosis than lateral tumors when all other factors are equal, indicating that understaging of ITN has a significant impact on patient outcomes. Medial tumors, deep tumors, young age, axillary nodal metastases, tumors of a high nuclear grade, lymphovascular invasion, and triple-negative hormone receptor status are predisposing factors for ITN metastases from primary BC. The presence of internal thoracic node (ITN) metastases upstages the breast cancer (BC) patient to a minimum of clinical stage III disease. The internal thoracic (IT) nodal basin is a first-echelon drainage pathway in the breast, accounting for up to a quarter of its lymphatic drainage, primarily from the deep structures of the breast. ![]()
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