Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging

Internal mammary lymph node (IMLN) metastasis forms part of the clinical node classification for primary breast cancer, which influences the treatment strategy. However, because of the IMLNs’ complicated anatomical structures and relationships with adjacent structures, IMLN biopsy or resection is associated with a limited improvement in prognosis and a high complication rate. The positivity rate also varies broadly according to imaging modality, and there is a low rate of agreement between the imaging and pathological diagnoses, which creates imprecision in the preoperative staging. The IMLN positivity rate also varies remarkably, and there are no clear, accurate, and non-invasive modalities for diagnosing the pre-mastectomy IMLN status. Nevertheless, medical imaging modalities continue to evolve, with functional imaging and image-guided thoracoscopic biopsy of sentinel IMLNs being well established. Thus, personalized decision-making and treatment selection should be based on the modality-specific differences in the diagnosis of IMLN metastasis/recurrence and the patient’s specific risk factors.