Skip to main content

Advertisement

SpringerLink
Log in

Internal Mammary Sentinel Node Biopsy in Breast Cancer. Is it Indicated?

  • Research
  • Published:
Pathology & Oncology Research

Abstract

Axillary sentinel node (A-SN) biopsy is a standard procedure in breast cancer surgery. Sampling of intenal mammary sentinel nodes (IM-SN) is not performed routinly, although it is also considered an important prognostic factor of breast cancer. The role of this latter procedure was investigated in cases of IM-SN visualized on lymphoscintigraphy. Between January 2001 and June 2012 1542 patients with clinically node negative operable primary breast cancer had sentinel node biopsy (SNB). Both axillary and IM-SN were sampled (whenever detected), based on lymphoscintigraphy, intraoperative gamma probe detection and blu dye mapping. Lymphoscintigraphy showed IM-SN in 83 cases. IM-SN biopsy (IM-SNB) was succesfull in 77 patients (93 %). A total of 86 IM-SNs were removed. IM-SN involvement was identified in 14 cases, representing 18 % of patients who underwent IM-SNB. This included macrometastases (MAC) in 5 cases, micrometastases (MIC) in 2 cases, isolated tumor cells (ITC) in 7 cases. No significant differences were found between patients with and without IM-SN involvement in terms of age, tumor location, tumor size, axillary involvement, tumor grade or estrogen receptor status. The IM-SN involvement has lead to new therapeutic indications in 2 cases (2.6 %), both of them due to MAC in the IM-SN: in 1 case change in chemotherapy and in 1 case change in radiotherapy, with the addition of iradiation of the internal mammary chain. Based on this series and information from the literature, we conclude that the indication for an IM-SNB procedure is very limited and its routine use should not be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 339:941–946

    Article  CAS  PubMed  Google Scholar 

  2. Giuliano AE, Jones RC, Brennan M, Statman R (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15:2345–2350

    CAS  PubMed  Google Scholar 

  3. Veronesi U, Paganelli G, Galimberti V et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349:1864–1867

    Article  CAS  PubMed  Google Scholar 

  4. Uren RF, Howman-Giles RB, Thompson JF et al (1995) Mammary lymphoscintigraphy in breast cancer. J Nucl Med 36:1775–1780

    CAS  PubMed  Google Scholar 

  5. Lamonica D, Edge SB, Hurd T et al (2003) Mammographic and clinical predictors of drainage patterns in breast lymphoscintigrams obtained during sentinel node procedures. Clin Nucl Med 28:558–564

    Article  PubMed  Google Scholar 

  6. Van der Ent FW, Kengen RA, van der Pol HA et al (2001) Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 234:79–84

    Article  PubMed  Google Scholar 

  7. Estourgie SH, Nieweg OE, Valdes Olmos RA et al (2004) Lymphatic drainage patterns from the breast. Ann Surg 239:232–237

    Article  PubMed  Google Scholar 

  8. Estourgie SH, Tanis PJ, Nieweg OE et al (2003) Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients. Ann Surg Oncol 10:935–941

    Article  PubMed  Google Scholar 

  9. Cserni G, Pap Szekeres J (2001) Internal mammary lymph nodes and sentinel node biopsy in breast cancer. Surg Oncol 10:25–33

    Article  CAS  PubMed  Google Scholar 

  10. Veronesi U, Cascinelli N, Bufalino R et al (1983) Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg 198:681

    Article  CAS  PubMed  Google Scholar 

  11. Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY et al (2003) Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer 39:170–174

    Article  CAS  PubMed  Google Scholar 

  12. Sapino A, Cassoni P, Zanon E et al (2003) Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 88:702–706

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Ambrózay E, Cserni G, Serényi P et al (2004) The role of axillary nodal staging during preoperative breast diagnostics. Eur J Cancer Suppl 2:92–93

    Article  Google Scholar 

  14. Gennari R, Galimberti V, De Cicco C et al (2000) Use of technetium-99m-labeled colloid albumin for preoperative and intraoperative localization of nonpalpable breast lesions. J Am Coll Surg 1 90:692–699

    Article  Google Scholar 

  15. Cserni G (2002) Complete sectioning of axillary sentinel nodes in patients with breast cancer. Analysis of two different step sectioning and immunohistochemistry protocols in 246 patients. J Clin Pathol 55:926–931

    Article  CAS  PubMed  Google Scholar 

  16. Greene FL, Page DL, Fleming ID et al (eds) (2002) AJCC Cancer Staging Hanbook New York. Springer, Berlin, p 469

    Google Scholar 

  17. Hultborn KA, Larsson LG, Ragnhult I (1955) The lymph drainage from the breast to the axillary and parasternal lymph nodes, studied with the aid of colloidal AU198. Acta Radiol 43:52–64

    Article  CAS  PubMed  Google Scholar 

  18. Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582

    Article  CAS  PubMed  Google Scholar 

  19. Heuts EM, van der Ent FW, Hulsewe KWE, von Meyenfeldt MF, Voogd EM (2009) Internal mammary lymph drainage and sentinel node biopsy in breast cancer- A study on 1008 patients. Eur J Cancer Surgery 35:252–257

    CAS  Google Scholar 

  20. Nathan J, Boyages J, French JR, Ung OA (2008) Internal mammary sentinel nodes: ignore, irradiate or operate? Eur J Cancer 45:789–794

    Google Scholar 

  21. Veronesi U, Cascinelli N, Greco M et al (1985) Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 202(6):702–707

    Article  CAS  PubMed  Google Scholar 

  22. Madsen E, Gobardhan PD, Bongers V et al (2007) The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 14:1486–1492

    Article  PubMed Central  PubMed  Google Scholar 

  23. Roumen RMH, Geuskens LM, Valkenburg JGH et al (1999) In search of the true sentinel node by different injection techniques in breast cancer patients. Eur J Surg Oncol 25:347–351

    Article  CAS  PubMed  Google Scholar 

  24. Borgstein PJ, Meijer S, Pijpers RJ, van Diest PJ (2000) Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg 1(81–89)

    Google Scholar 

  25. Spillane AJ, Noushi F, Cooper RA, Gebski V, Uren RF (2009) High-resolution lymphoscintigraphy is essential for recognition of the significance of internal mammary nodes in breast cancer. Ann Oncol 20:977–984

    Article  CAS  PubMed  Google Scholar 

  26. Sugg SL, Ferguson DJ, Posner MC, Heimann R (2000) Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncical Oncol 7:188–192

    Article  CAS  Google Scholar 

  27. Van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG (2001) Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 234(1):79–84

    Article  PubMed  Google Scholar 

  28. Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danisch Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648

    Article  CAS  PubMed  Google Scholar 

  29. Ragaz J, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962

    Article  CAS  PubMed  Google Scholar 

  30. Whelan TJ, Julian J, Wright J et al (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220–1229

    CAS  PubMed  Google Scholar 

  31. Obedian E, Hafty BG (1999) Internal mammary nodal irradiation in conservatively managed breast cancer patients: is there a benefit? Int J Radiat Oncol Biol Phys 44(5):997–1003

    Article  CAS  PubMed  Google Scholar 

  32. Freedman GM, Fowble BL, Nicolaou N et al (2000) Should internal mammary lymph nodes in breast cancer be the target for the radiation oncologist? Int J Radiat Oncol Biol Phys 46:805–814

    Article  CAS  PubMed  Google Scholar 

  33. Jatoi I (2003) Internal mammary sentinel nodes in primary breast cancer. Curr Med Res Opin 19:567–569

    Article  PubMed  Google Scholar 

  34. Fowble B, Hanlon A, Freedman G et al (2000) Internal mammary node irradiation neither decreases distant metastases nor improves survival in stage I and II breast cancer. Int J Radiat Oncol Biol Phys 47:883–894

    Article  CAS  PubMed  Google Scholar 

  35. Matzinger O, Heimsoth I, Poortmans P et al (2010) Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer (EORTC trial 22922/10925) Act. Oncol 49:24–34

    Google Scholar 

  36. Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

    CAS  PubMed  Google Scholar 

  37. Early Breast Cancer Trialists’ Collaborative Group (EBCTGC) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer: effects on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Article  Google Scholar 

  38. Dutch national guideline for the treatment of breast cancer, version 2.0 (Feb 2012). http://www.oncoline.nl/mammacarcinoom. Accessed 22 Feb 2012

  39. Coombs NJ, Boyages J, French JR et al (2009) Internal mammary sentinel nodes: ignore, irradiate or operate? Eur J Cancer 45:789–794

    Article  PubMed  Google Scholar 

  40. Heuts EM, van der Ent FW, Hulsewe KWE, von Meyenfeldt MF, Voogd EM (2009) Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases. The Breast 18:254–258

    Article  CAS  PubMed  Google Scholar 

  41. Postma EL, van Wieringen S, Hobbelink MG et al (2012) Sentinel lymph node biopsy of the internal mammary chain in breast cancer. Breast Cancer Res Treat 134:735–774

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Leidenius MHK, Krogerud LA, Toivonen TS et al (2006) The clinical value of parasternal sentinel node biopsy in breast cancer. Ann Surg Oncol 13(3):321–326

    Article  PubMed  Google Scholar 

  43. Cserni G (2007) What is a positive sentinel lymph node in a breast cancer patient? A practical approach. Breast 16:152–160

    Article  PubMed  Google Scholar 

  44. Lázár G, Besznyák I, Boross G et al (2010) Az emlőrák korszerű sebészi kezelése. M Onkol 54:227–236

    Article  Google Scholar 

Download references

Conflict of Interest Statement

None declared

Author information

Authors and Affiliations

  1. Department of Surgery, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    R. Maráz, G. Boross & J. Pap-Szekeres

  2. Department of Oncology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    R. Maráz

  3. Department of Nuclear Medicine, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    M. Rajtár

  4. Department of Breast Diagnostics, Mamma Zrt at the Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    E. Ambrózay

  5. Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    G. Cserni

  6. Department of Pathology, University of Szeged, Szeged, Hungary

    G. Cserni

  7. Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét, 6000, Hungary

    R. Maráz

Authors
  1. R. Maráz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Boross
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Pap-Szekeres
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Rajtár
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Ambrózay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Cserni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Maráz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maráz, R., Boross, G., Pap-Szekeres, J. et al. Internal Mammary Sentinel Node Biopsy in Breast Cancer. Is it Indicated?. Pathol. Oncol. Res. 20, 169–177 (2014). https://doi.org/10.1007/s12253-013-9680-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12253-013-9680-7

Keywords

Search

Navigation