Internal Mammary Lymph Node Drainage Patterns in Patients With Breast Cancer Documented by Breast Lymphoscintigraphy
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background: Metastases to internal mammary lymph nodes (IMN) may occur in patients with breast cancer and may alter treatment recommendations. The purpose of this study was to identify the frequency of IMN drainage in patients undergoing breast lymphoscintigraphy and sentinel lymph node dissection (SLND).
Methods: The combined technique of peritumoral injection of radiocolloid and Lymphazurin blue for SLND was performed on 220 patients. All patients underwent preoperative lymphoscintigraphy before SLND. Lesion location by quadrant included: 110 upper outer (UOQ), 49 lower outer (LOQ), 30 upper inner (UIQ), 24 lower inner (LIQ), and 7 central.
Results: Drainage to any nodal basin was observed in 184 of 220 patients (84%). IMN drainage was documented in 37 of 220 (17%) of patients. IMN drainage without evidence of axillary drainage occurred in 2 of 220 patients(1%). Drainage to the IMN based on quadrant location of the lesion was as follows: UOQ, 10%; LOQ, 27%; UIQ, 17%; LIQ, 25%; and central, 29%.
Conclusions: Internal mammary lymph node drainage shown by breast lymphoscintigraphy is common. Tumors in all quadrants may drain to IMNs, although drainage is significantly more common from quadrants other than the UOQ. Further studies are needed to determine whether lymphoscintigraphy drainage patterns identify patients at the highest risk for IMN metastases who may benefit from radiotherapy.
- Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220: 391–401.
- Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2: 335–40. CrossRef
- Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276: 1818–22. CrossRef
- Veronesi U, Paganelli B, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349: 1864–7. CrossRef
- Freedman GM, Fowble BL, Nicolaou N, Sigurdson ER, Torosian MH, Boraas MC, Hoffman JP. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiation Oncology Biol Phys 2000; 46: 805–14.
- Fowble B, Gray R, Gilchrist K, Goodman RL, Taylor S, Tormey DC. Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy. J Clin Oncol 1988; 6: 1107–17.
- Marks LB, Halperin EC, Prosnitz LR, Ross M, Vredenburgh JJ, Rosner GL, Peters W. Post-mastectomy radiotherapy following adjuvant chemotherapy and autologous bone marrow transplantation for breast cancer patients with ≥ 10 positive axillary lymph nodes. Int J Radiat Oncol Biol Phys 1992; 23: 1021–6.
- Buzdar AU, McNeese MD, Hortobagyi GN, et al. Is chemotherapy effective in reducing the local failure rate in patients with operable breast cancer? Cancer 1990; 65: 394–9.
- Stefanik D, Goldberg R, Byrne P, et al. Local-regional failure in patients treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1985; 3: 660–5.
- Lacour J, LeM, Caceres E, Koszarowski T, Veronesi U, Hill C. Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten year results of an international cooperative trial in breast cancer. Cancer 1983; 51: 1941–3.
- Veronesi U, Cascinelli N, Greco M, et al. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 1985; 202: 702–7.
- Meier P, Ferguson DJ, Karrison T. A controlled trial of extended radical versus radical mastectomy. Ten-year results. Cancer 1989; 63: 188–95.
- Donegan WL. The influence of untreated internal mammary metastases upon the course of mammary cancer. Cancer 1977; 39: 533–8.
- Veronesi U, Cascinelli N, Bufalino R, et al. Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg 1983; 198: 681–4.
- Sugg SL, Ferguson DJ, Posner MC, Heimann R. Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol 2000; 7: 188–92.
- Overgaard M, Hansen PS, Overgaard J. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997; 337: 949–55.
- Ragaz J, Jackson SM, LeN. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 1997; 337: 956–62.
- Overgaard M, Jensen M, Overgaard J. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 1999; 353: 1641–8.
- Buchholz TA. Internal mammary lymph nodes: to treat or not to treat. Int J Radiation Oncology Biol Phys 2000; 46: 801–3.
- Turner-Warwick RT. The lymphatics of the breast. Br J Surg 1953; :46: 574–82.
- Hultborn KA, Larsen LG, Ragnhult I. The lymph drainage from the breast to the axillary and parasternal lymph nodes, studied with the aid of colloidal Au198. Acta Radiol 1955; 43: 52–64.
- Vendrell-Torne E, Setoain-Quinqer J, Domenech-Torne FM. Study of normal lymphatic drainage using radioactive isotopes. J Nucl Med 1972; 13: 801–5.
- Uren RF, Howman-Giles RB, Thompson JF, Malouf D, Ramsey-Stewart G, Niesche FW, Renwick SB. Mammary lymphoscintigraphy in breast cancer. J Nucl Med 1995; 36: 1775–80.
- Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer. A multicenter validation study. N Engl J Med 1998; 339: 941–6. CrossRef
- Van der Ent FC, Kengen RM, Van der Pol HG, Hoofwijk AM. Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer. Eur J Surg Oncol 1999; 25: 24–9.
- Noguchi M, Tsugawa K, Miwa K. Internal mammary chain sentinel node identification in breast cancer. J Surg Oncol 2000; 73: 75–80.
- Linehan DC, Hill ADK, Akhurst T, et al. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 1999; 6: 450–4.
- Dunnwald LK, Mankoff DA, Byrd DR, Anderson BO, Moe RE, Yeung RS, Eary JF. Technical aspects of sentinel node lymphoscintigraphy for breast cancer. J Nucl Med Technol 1999; 27: 106–11.
- Eary JF, Mankoff DA, Dunnwald LK, Byrd DR, Anderson BO, Yeung RS, Moe RE. Sentinel lymph node mapping for breast cancer: analysis in a diverse patient group. Radiology 1999; 213: 526–9.
- Handley RS, Thackray AC. Invasion of internal mammary lymph nodes in carcinoma of the breast. BMJ 1954; 1: 61–3. CrossRef
- Veronesi U, Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer 1981; 47: 170–5.
- Norman J, Cruse W, Ruas E, et al. The expanding role of lymphoscintigraphy in the management of cutaneous melanoma. Am Surg 1989; 55: 689–94.
- Norman J, Cruse CW, Espinosa C, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma. Am J Surg 1991; 162: 432–7.
- Uren RF, Howman-Giles RB, Shaw HM, Thompson JF, McCarthy WH. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med 1993; 34: 1435–40.
- Paganelli G, Cicco CD. Sentinel node biopsy. Reply to Bourgeois et al. Eur J Nucl Med 1998; 25: 1589–90.
- Borgstein PJ, Pijpers R, Comans EF, Van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186: 275–83. CrossRef
- Roumen RM, Valkenburg JG, Geuskens LM. Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer. Eur J Surg Oncol 1997; 23: 495–502.
- O’Hea BJ, Hill AD, El-Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg 1998; 186: 423–7.
- Jansen L, Nieweg OE, Vries JD, et al. Lymphoscintigraphy to identify unusual locations of sentinel lymph nodes in patients with breast cancer (abstract). J Nucl Med 1999; 40: 18P.
- Ollila DW, Haigh PI, Hansen NM. Lymphatic drainage patterns of medial breast carcinomas. Breast Cancer Res Treat 1998; 50: 258.
- Internal Mammary Lymph Node Drainage Patterns in Patients With Breast Cancer Documented by Breast Lymphoscintigraphy
Annals of Surgical Oncology
Volume 8, Issue 3 , pp 234-240
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Internal mammary
- Sentinel lymph node
- Breast cancer
- Industry Sectors
- Author Affiliations
- 1. Department of General Surgery, Section of Surgical Oncology, Seattle, Washington
- 3. Dept. of Surgery, University of Washington Medical Center, Box 356410, 1959 N.E. Pacific St., Seattle, WA, 98195
- 2. Division of Nuclear Medicine, University of Washington Medical Center, Seattle, Washington