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Annals of Surgical Oncology

, Volume 10, Issue 8, pp 935–941 | Cite as

Should the Hunt for Internal Mammary Chain Sentinel Nodes Begin? An Evaluation of 150 Breast Cancer Patients

  • Susanne H. Estourgie
  • Pieter J. Tanis
  • Omgo E. Nieweg
  • Renato A. Valdés Olmos
  • Emiel J. Th. Rutgers
  • Bin B. R. Kroon
Original Articles

Abstract

Background: The aim of this study was to determine the visualization rate, identification rate, and clinical implications of biopsy of sentinel nodes in the internal mammary chain (IMC) in patients with breast cancer.

Methods: From January 1999 to December 2002, 691 sentinel node procedures were performed. Preoperative lymphoscintigraphy was performed after injection of 99mTc-labeled nanocolloid into the tumor (.2 mL; 115 MBq; 3.1 mCi). The sentinel node was surgically identified with the aid of patent blue dye and a gamma ray detection probe.

Results: The sentinel node in the IMC could be harvested in 130 (87%) of the 150 patients in whom it was visualized on the images and contained metastases in 22 (17%) of these 130 cases. In nine patients (7%), the IMC sentinel node was tumor positive, whereas the axilla was tumor-free. Stage migration was seen in all patients with a tumor-positive IMC sentinel node (17%). There was a change of management in 38 (29%) of the 130 patients: institution or omission of radiotherapy to the IMC, adjuvant systemic therapy, or omission of an axillary lymph node dissection.

Conclusions: Pursuit of IMC sentinel nodes improves the staging of patients with breast cancer and enables treatment to be better adjusted to the needs of the individual patient.

Key Words

Breast neoplasms Internal mammary lymph node chain Sentinel node biopsy Neoplasm staging 

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REFERENCES

  1. 1.
    Camper P. Over den waren aart der kankervorming en over een zeer zakelijk en onfeilbaar teken van onherstelbaaren borstkanker. Geneeskd Nat Huishoudkd Kabinet 1779;2:193–208.Google Scholar
  2. 2.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Veronesi U, Marubini E, Mariani L, et al. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer 1999;35:1320–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lacour J, Le MG, Hill C, et al. Is it useful to remove internal mammary nodes in operable breast cancer? Eur J Surg Oncol 1987;13:309–14.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Donegan WL. The influence of untreated internal mammary metastases upon the course of mammary cancer. Cancer 1977;39:533–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bevilacqua JL, Gucciardo G, Cody HS, et al. A selection algorithm for internal mammary sentinel lymph node biopsy in breast cancer. Eur J Surg Oncol 2002;28:603–14.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cody HS III, Urban JA. Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol 1995;2:32–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Noguchi M, Ohta N, Thomas M. Risk of internal mammary lymph node metastases and its prognositc value in breast cancer patients. J Surg Oncol 1993;52:26–30.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Handley RS. Carcinoma of the breast. Ann R Coll Surg Engl 1975;57:59–66.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Urban JA. Management of operable breast cancer. The surgeon’s view. Cancer 1978;42:2066–77.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sugg SL, Ferguson DJ, Posner MC, et al. Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol 2000;7:188–92.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jansen L, Nieweg OE, Valdés Olmos RA, et al. Improved staging of breast cancer through lymphatic mapping and sentinel node biopsy. Eur J Surg Oncol 1998;24:445–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Galimberti V, Veronesi P, Arnone P, et al. Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol 2002;9:924–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Van der Ent FW, Kengen RA, van der Pol HA, et al. Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 2001;234:79–84.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dupont E, Cox CE, Nguyen K, et al. Utility of internal mammary lymph node removal when noted by intraoperative gamma probe detection. Ann Surg Oncol 2001;8:833–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer 2002;87:705–10.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tanis PJ, Deurloo EE, Valdés Olmos RA, et al. Single intralesional tracer dose for radio-guided excision of clinically occult breast cancer and sentinel node. Ann Surg Oncol 2001;8:850–5.CrossRefGoogle Scholar
  18. 18.
    Sobin LH, Wittekind C. TNM Classification of Malignant Tumours. 6th ed. New York:: Wiley-Liss, 2002.Google Scholar
  19. 19.
    Valdés Olmos RA, Tanis PJ, Hoefnagel CA, et al. Improved sentinel node visualization in breast cancer by optimizing the colloid particle concentration and tracer dosage. Nucl Med Commun 2001;22:579–86.CrossRefGoogle Scholar
  20. 20.
    Shen P, Glass EC, DiFronzo LA, et al. Dermal versus intraparenchymal lymphoscintigraphy of the breast. Ann Surg Oncol 2001;8:241–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Paganelli G, Galimberti V, Trifiro G, et al. Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 2002;46:138–44.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Estourgie SH, Nieweg OE, Valdés Olmos RA, et al., Lymphatic drainage patterns from the breast. Paper presented at: 56th Annual Cancer Symposium of the Society of Surgical Oncology; March 5–9, 2003; Los Angeles, CA.Google Scholar
  23. 23.
    Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg 2001;192:399–409.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Caplan I. Revision anatomique du systeme lymphatique de la glande mammaire (a propos de 200 cas). Bull Assoc Anat (Nancy) 1975;59:121–37.Google Scholar
  25. 25.
    Haagensen CD, Feind CR, Herter FP, et al. The Lymphatics in Cancer. Philadelphia:: WB Saunders, 1972.Google Scholar
  26. 26.
    Silverstein MJ, Gierson ED, Waisman JR, et al. Predicting axillary node positivity in patients with invasive carcinoma of the breast by using a combination of T category and palpability. J Am Coll Surg 1995;180:700–4.PubMedGoogle Scholar
  27. 27.
    Byrd DR, Dunnwald LK, Mankoff DA, et al. Internal mammary lymph node drainage patterns in patients with breast cancer documented by breast lymphoscintigraphy. Ann Surg Oncol 2001;8:234–40.CrossRefPubMedGoogle Scholar
  28. 28.
    Arriagada R, Le MG, Mouriesse H, et al. Long-term effect of internal mammary chain treatment. Results of a multivariate analysis of 1195 patients with operable breast cancer and positive axillary nodes. Radiother Oncol 1988;11:213–22.CrossRefPubMedGoogle Scholar
  29. 29.
    Rutqvist LE, Johansson H. Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry. Br J Cancer 1990;61:866–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Rutqvist LE, Lax I, Fornander T, et al. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 1992;22:887–96.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Host H, Brennhovd IO, Loeb M. Postoperative radiotherapy in breast cancer—long-term results from the Oslo study. Int J Radiat Oncol Biol Phys 1986;12:727–32.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hojris I, Overgaard M, Christensen JJ, et al. Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet 1999;354:1425–30.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Marks LB, Hebert ME, Bentel G, et al. To treat or not to treat the internal mammary nodes: a possible compromise. Int J Radiat Oncol Biol Phys 1994;29:903–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Susanne H. Estourgie
    • 1
    • 4
  • Pieter J. Tanis
    • 3
  • Omgo E. Nieweg
    • 1
  • Renato A. Valdés Olmos
    • 2
  • Emiel J. Th. Rutgers
    • 1
  • Bin B. R. Kroon
    • 1
  1. 1.Department of SurgeryThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Nuclear MedicineThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of SurgerySint Lucas Andreas HospitalAmsterdamThe Netherlands
  4. 4.Department of SurgeryThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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