Korean J Radiol.  2013 Aug;14(4):576-580. 10.3348/kjr.2013.14.4.576.

Diagnosis of a Malignant Intramammary Node Retrospectively Aided by Mastectomy Specimen MRI-Is the Search Worth It? A Case Report and Review of Current Literature

• Mahajan A
• Udare A
• Shet T
• Juvekar S
• Thakur M

• KMID: 1715761
• DOI: http://doi.org/10.3348/kjr.2013.14.4.576

Abstract

Metastases to intramammary nodes have been shown to be an independent predictor of poor outcome in patients with breast cancer, such as axillary lymph node metastases. The detection and accurate characterization of these nodes preoperatively is thus crucial for the staging and planning of treatment for breast carcinoma, particularly in cases with axillary lymph node negative disease as it upgrades the disease staging. We herein report the first case where we detected an intra-mammary node on specimen MRI after the primary pathological gross specimen evaluation failed to detect the node.

Keyword

Breast Cancer; Intramammary node; Magnetic resonance imaging

MeSH Terms

Axilla
Breast Neoplasms/*diagnosis/pathology/surgery
Diagnosis, Differential
Female
Humans
Lymph Nodes/*pathology
Lymphatic Metastasis
Magnetic Resonance Imaging/*methods
*Mastectomy
Middle Aged
Neoplasm Staging
Retrospective Studies

Figure

• 

  Fig. 1 Digital mammography (A), magnetic resonance imaging of the breast (B-E), targetted USG (F), post opearative specimen MRI (G), photograph of resected specimen (H), and photomicrograph from obtained after localisation (I). A. Mammogram of right breast shows mixed fibrofatty and glandular parenchyma with high density mass in upper outer quadrant of right breast with perilesional architectural distortion and spiculations measuring approximately 1.3 × 1.1 cm. Centimeter sized axillary node is also noted. Other than these, no other suspicious lesion is noted. Left breast was normal. B-E. Precontrast axial T1W depicting tiny hypointense nodule noted at 12 o'clock position in right breast (B) which appears hyperintense on precontrast (C). Postcontrast T1W axial (D) and sagittal images (E) of breast showing nodule in right breast. STIR = Short Tau Inversion Recovery, T1W = T1 weighted F. Ultrasonography of right breast showing tiny hypoechoic nodule with rim of hyperechoic tissue in 12 o'clock position. FNAC was performed in same setting, which was negative for malignancy. G. STIR MRI sequence of resected breast specimen shows hyperintense nodule in specimen. H. Photograph of resected specimen with methylene blue injected at suspicious site, which was localized using STIR MRI sequence. I. Photomicrograph obtained from site after localization of lesion using methylene blue shows metastatic ductal carcinoma cells along sinuses (HFE: 100). STIR = Short Tau Inversion Recovery,

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