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Should internal mammary nodes be sampled in the sentinel lymph node era?

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Abstract

Background

Controversy exists regarding internal mammary lymph nodes (IMNs) in the staging and treatment of breast cancer. Sentinel lymph node identification with radiocolloid can map drainage to IMNs and directed biopsy can be performed with minimal morbidity. Furthermore, recent studies suggest that IMN drainage of breast tumors may be underestimated. To gain further insight into the prognostic value of IMNs, we reviewed the outcome of patients in whom the IMN status was routinely assessed.

Methods

A retrospective review of 286 patients with breast cancer who underwent IMN dissection between 1956 and 1987 was conducted.

Results

Median follow-up is 186 months, age was 52 years (range, 21–85 years), tumor size was 2.5 cm, and number of IMNs removed was 5 (range, 1–22); 44% received chemotherapy, 16% endocrine therapy, and 5% radiotherapy. Presence of IMN metastases correlated with primary tumor size (P<.0001) and number of positive axillary nodes (P<.0001) but did not correlate with primary tumor location or age. Overall, the 20-year disease-free survival is significantly worse for the 25% of patients with IMN metastases (P<.0001). In patients with positive axillary nodes and tumors smaller than 2 cm, there was a significantly worse survival (P<.0001) in the patients with IMN metastases. This difference in survival was not seen in women with tumors larger than 2 cm.

Conclusions

Patients with IMN metastases, regardless of axillary node status, have a highly significant decrease in 20-year disease-free survival. Treatment strategies based on knowledge of sentinel IMN status may lead to improvement in survival, especially for patients with small tumors. At present, sentinel IMN biopsies should be performed in a clinical trial setting.

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References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. Noguchi M, Ohta N, Thomas M, et al. Risk of internal mammary lymph node metastases and its prognostic value in breast cancer patients.J Surg Oncol 1993;52:26–30.

    PubMed  CAS  Google Scholar 

  3. cody HS 3rd, Urban JA. Internal mammary node status: a major prognosticator in axillary node-negative breast cancer.Ann Surg Oncol 1995;2:32–7.

    Article  PubMed  Google Scholar 

  4. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe,Surg Oncol 1993;2:335–40.

    Article  PubMed  CAS  Google Scholar 

  5. 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.

    Article  PubMed  CAS  Google Scholar 

  6. Uren RF, Howman-Giles RB, Thompson JF, et al. Mammary lymphoscintigraphy in breast cancer (comment).J Nucl Med 1995; 36:1775–80.

    PubMed  CAS  Google Scholar 

  7. Kaplan E, Meier P. Nonparametric estimation from incomplete observations,J Am Stat Assoc 1958;53:457–481.

    Article  Google Scholar 

  8. 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.

    PubMed  CAS  Google Scholar 

  9. Handley RS. Carcinoma of the breast.Ann R Coll Surg Engl 1975;57:59–66.

    PubMed  CAS  Google Scholar 

  10. Haagensen C. Natural history of breast carcinoma. In:Diseases of the Breast. 3rd ed. Philadelphia: WB Saunders, 1986;635–718.

    Google Scholar 

  11. Lacour J, Le M, Caceres E, et al. 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.

    Article  PubMed  CAS  Google Scholar 

  12. 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 (comment).J Am Coll Surg 1998;186: 423–7.

    Article  PubMed  CAS  Google Scholar 

  13. Morrow M, Foster RS Jr. Staging of breast cancer: a new rationale for internal mammary node biopsy.Arch Surg 1981;116:748–51.

    PubMed  CAS  Google Scholar 

  14. Noguchi M, Michigishi T, Nakajima K, et al. The diagnosis of internal mammary node metastases of breast cancer.Int Surg 1993;78:171–5.

    PubMed  CAS  Google Scholar 

  15. Caceres E. Incidence of metastases in the internal mammary chain in operable cancer of the breast.Surg Gynecol Obstet 1959;108: 715–720.

    PubMed  CAS  Google Scholar 

  16. Urban J. Radical mastectomy with en bloc in continuity resection of the internal mammary lymph node chain.Surg Clin North Am 1956;36:1065–1082.

    Google Scholar 

  17. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer.J Clin Oncol 1997;15:2345–50.

    PubMed  CAS  Google Scholar 

  18. Hellman S. Stopping metastases at their source (editorial).N Engl J Med 1997;337:996–7.

    Article  PubMed  CAS  Google Scholar 

  19. Evans RA. Radiotherapy and chemotherapy in high-risk breast cancer (letter).N Engl J Med 1998;338:331–2.

    PubMed  CAS  Google Scholar 

  20. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial (comment).N Engl J Med 1997;337:949–55.

    Article  PubMed  CAS  Google Scholar 

  21. Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer (comment).N Engl J Med 1997;337:956–62.

    Article  PubMed  CAS  Google Scholar 

  22. Meier P, Ferguson DJ, Karrison T. A controlled trial of extended radical versus radical mastectomy: ten-year results.Cancer 1989; 63:188–95.

    Article  PubMed  CAS  Google Scholar 

  23. Le MG, Arriagada R, de Vathaire F, et al. Can internal mammary chain treatment decrease the risk of death for patients with medial breast cancers and positive axillary lymph nodes (comment).Cancer 1990;66:2313–8.

    Article  PubMed  CAS  Google Scholar 

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Sugg, S.L., Ferguson, D.J., Posner, M.C. et al. Should internal mammary nodes be sampled in the sentinel lymph node era?. Annals of Surgical Oncology 7, 188–192 (2000). https://doi.org/10.1007/BF02523652

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  • DOI: https://doi.org/10.1007/BF02523652

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