Intramammary Node --What does it all mean?

[jeremiah2911]

A core needle biopsy revealed I had a 1.2 cm invasive ductal carcinoma tumor, grade 1, ER/PR +, HER-, K-67 score was 18 (borderline). I went in for a lumpectomy on Oct. 11-- but   as they were inserting the wire, they found another spot.  The MRI I had the week before did not show anything.  My surgeon removed both masses in one scoop. The new spot was said to be an intramammary lymph node (located .6 cm above my 1.2 cm tumor and it was also .6 cm in size, completely mastesized).  My surgeon did not get clear margins and now wants to do a mastectomy.  Two sentinal nodes were removed and they were clear which she said was really good news.  What significance does the intramammary lymph node mean?  Is it good/bad because it was  very close to the tumor? Is it common for an MRI not to pick this up?   How common is it to have intramammary involvement?  Both tumors, when combined,  would be less than 2 cm.  If my sentinal nodes are clear, and it is a grade 1 tumor, what are the chances of it spreading?  The first tumor was found on a routine mammogram which I get annually.  I am 43.  Thanks in advance for your help.

[Fernando Roque, MD]

You don't usually find lymph nodes inside the breast itself, or "intramammary", so I assumed that the report was referring to the internal mammary nodes, which is one of the sites where breast cancer usually spreads to.  But I shall try to look into the literature for data on intramammary nodes and will keep you posted.

[jeremiah2911]

Isnt' there a difference between an INTERNAL mammary node and an INTRAmammary node?    The INTRAmammary node was removed and did contain cancer.  My doctor doesn't really know the significance other than it passed through a blood vessel, she recommends a mastectomy, and  I would more than likely need chemo.  Do you have any other info on the INTRAmammary--not the intermammary lymph node.?  Thanks.  

[Fernando Roque, MD]

You have several questions which I have listed, together with some answers below:

1.  What significance does the intramammary lymph node mean?
From the information you gave me, I am assuming that your surgeon found a suspicious looking internal mammary node and had it removed.  This node needs to undergo evaluation by a pathologist before we can say that it is positive for malignant cells.  Now, IF this node were indeed positive for malignant cells, this does have an effect on the staging and treatment of the cancer.  I think your doctor is in the best position to discuss with you the implications of a positive internal mammary node, so please ask him about it.

2.  Is it common for an MRI not to pick this up?
A study evaluating the accuracy of MRI for detecting internal mammary nodes greater than 5 mm showed an accuracy of 90.7% and a sensitivity of 93.3%.  So there is roughly a 7-10% chance that the internal mammary node that your surgeon detected in the operation would not be detected by MRI.

3.  What are the chances of it spreading?
Before this question can be answered, the STAGE of the cancer has to be established.  Again, I think your doctor is in the best position to discuss this with you.