intramammary nodes.. tested?

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Newbie21
Newbie21 Member Posts: 70
edited June 2014 in Not Diagnosed With a Recurrence or Metastases but Concerned

Hi,

 Was wondering why the IMN's are not tested? Or are they?  Shouldn't they be though routinely since this is also another avenue the BC can go? I am sure docs know what quadrant drains where, right? Confused and concerned.  Please help. ps. i mean internal mammary and not intramammary.

Giu

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  • Brenda_R
    Brenda_R Member Posts: 509
    edited June 2009

    Some of them are under the breastbone and almost impossible to get to.

    I had a Pet/ct scan that showed my positive IM node. Otherwise we may not have known about it. 

    I encourage anyone that has a tumor in the inner breast quadrant, to get a pet/ct, because it would most likely drain into the IM chain.

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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited June 2009

    About one-third of intramammary nodes (IMN) are positive by SLN technique for outside the axilla drainage from what I understand. Drainage into the IMN is not the same as positive cancer cells in the IMN node however, which by percentage is significantly less.The highest percent are found with tumors in the medial (inner) quadrent, then next high is middle breast lesions, and least in upper outer quadrant. I was reading about this last night. The author suggested radioactive dye lymph studies to outline the flow in the breast. I'd think (but don't know) that as Brenda says, a Pet/Ct is easier, but this omits comment on which picks up smaller amounst of disease better.

    If one does have a +IMN (the IMN's being a cross station to the abdominal cavity and lower body) radiation can be added to that chain with good results, hopefully using computer stimulation technique which is more sophisticated and helps to limit left sided heart damage.

    Edit: One item I thought interesting is the role of sentinel lymph node dye/radioactivity and IMN's. You don't hear a lot of discussion about IMN's and the article pointed out some surgeons are hesistant to scan in the intramammery region due to the difficulty perhaps with their biopsy if positive and as always, treatment and survival effects..But, given the percent of positivity based on location of one's tumor, it may be important to make clear with your surgeon whether he/she will check if their is radioactivity in this location if possible. 

    Edit Two: Here is the reference which allows the full free article. I will read more of the article's references, as the less than 1/3 + IMN seems high. I also will add a note below to this effect and others might add what their understanding of positive IMN percentage is. The problem with biopsy is one of location of IMN's: it's difficult to bx them because they are covered by the pectoralis muscle and they are small, making their radioactive pickup more difficult.

    http://annonc.oxfordjournals.org/cgi/content/abstract/20/6/977

    Best,

    Tender

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  • Newbie21
    Newbie21 Member Posts: 70
    edited June 2009

    Hi,

    Well that angers me because when my mom was dxed 3 yrs ago no one mentioned this and I just found this out know and I think she had a tumour medially. Not right. We are supposed to know all when BC hits. Why don't some tell you about this or automatically get scanned there too?  Especially if one third go there.

    G

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  • Newbie21
    Newbie21 Member Posts: 70
    edited June 2009

    Brenda R- why did you get a pet? Thx. G

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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited June 2009

    Newbie,

    I added the citation or reference to my post above. Sorry, I usually give a reference right away, especially on a controversial issue such as IMN's. The reason diagnostic status of the intra-mammary nodes is not widely talked over with patients, as I understand it, in addition to the reality that the majority of the nodes are negative, is the difficulty of biopsy of the IMN chain. Treatment if diagnosed is typically radiation which carries it's own drawbacks (potential heart damage, esophageal/lung effects, secondary cancers).

    It's good to for me to review the many references on trials/studies of percentage of IMN positives at diagnosis. Just less than a third seems high, yet that is what the above article state. So I'll look around a bit more at this articles references.

    Perhaps PET/CT's are showing more IMN's than in the past as this is a relatively newer scan (and seems increasingly used, or a PET scan often at time of initial diagnosis nowadays. I never have had one nor was one offered some eight years ago).

    I'm sure your own oncologist will shed light on this issue as well as others here.

    Tender

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  • Brenda_R
    Brenda_R Member Posts: 509
    edited June 2009

    They ordered a pet/ct for me the same day I was diagnosed.  They listed "staging" as the reason.

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  • Brenda_R
    Brenda_R Member Posts: 509
    edited June 2009

    Tender, thanks for the link. It's hard to find much info on IM nodes.

    I just wanted to add that they made no attempt to biopsy or remove my IM node. I went through a grueling chemo and had rads targeted to that node. 

    The node lit up on the pet with a SUV value of 6.1 and it showed up on the ct part as a enlarged node. 

    I just thank goodness my surgeon ordered the scan.

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  • Member_of_the_Club
    Member_of_the_Club Member Posts: 3,646
    edited June 2009

    Tender, I love your posts but I am having trouble understanding this one.

    I think I was told by my radiation onc (long time ago, so I could be wrong) that when the primary tumor is in the upper outer quadrant, cancer cells go through the lymph system out the arm and not toward the IM nodes.  Does this make sense? 

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  • jacee
    jacee Member Posts: 1,384
    edited September 2009

    Ladies...my tumor(6mm) was on the line between lower/upper outer quadrant. SNB identified 2 sentinel nodes. 1 axillary and 1 internal mammary. Both were removed....both positive. Very unusual for a grade 1 <1cm tumor. In fact it was recommended to me to get a 2nd pathological opinion, so I sent my path slides to Johns Hopkins Breast Center. Same result. I would love to find a study to join concerning positive IMN's. I was fortunate to have mine removed...first one my surgeon had ever removed. In chemo now, then rads.

     Joni

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  • Mawsue
    Mawsue Member Posts: 1
    edited September 2009

    Jacee, I have recently had a pet scan show 3 internal mammary nodes, or another Dr. called them infra-mammary nodes enlarged.  The largest is up against my sternum measuring 1.2 cm.

    The other two are 3mm just  to the right.  I am a breast cancer surviver of three years now.  Take Tamoxifen everyday.  Anyway,  I am now awaiting the call from my oncologist who is consulting with radiologist and thoracic surgeons to see if it can be biopsied.  I'm worried.  I've read everything I can find on the subject and it sure hasn't helped much.  What is the are metastatic disease?  Is that it?

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  • Sukiann
    Sukiann Member Posts: 310
    edited September 2009

    I have a very bad feeling about this.  My surgeon mentioned nothing about it when I had my surgery in March.  My tumor was in the lower inner quadrant (between 6 and 8 o'clock) the perfect position for it to get to the IM nodes.  I am sooo scared.  I knew this was going to happen to me once I finished treatment (tomorrow is my last rads).  I'm getting myself all "whipped up into a frenzy".  I have been very positive about the whole thing but now I'm really starting to wonder if it's all gone.  Let's face it, I don't have the best case scenario (I know, even if you do you can still have a recurrance).  My tumor was 2.5 cm, in the lower inner quadrant, a micromet and I have an oncotype score of 32.  I'm going to ask my radiation oncologist about this tomorrow to see if she can shed some light on this subject.

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