Skip to main content

Advertisement

SpringerLink
Log in

Clinical relevance of sentinel lymph nodes in the internal mammary chain in breast cancer patients

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Despite the widespread use of sentinel lymph node (SLN) biopsy in breast cancer patients, some controversy exists about the correct management of extra-axillary nodes, especially those located in the internal mammary chain. The aim of this study was to evaluate the incidence of SLNs in this region, calculate the lymphoscintigraphic and surgical detection rates and evaluate the clinical impact on staging and therapeutic decisions.

Methods

The study involved 383 consecutive women diagnosed with early breast cancer with T1 or T2 tumours. Eight patients had a bilateral tumour, which brought the total to 391 lesions. Lymphoscintigraphy was performed on the day before surgery by injection of 99mTc-labelled nanocolloid. The injection site was subdermal (68 patients), peritumoural (107 patients) or intratumoural (216 patients). During surgery a gamma probe was used to guide the surgeon and the SLNs were removed. SLNs were analysed by a conventional pathological study and processed for H&E examination and immunohistochemistry.

Results

Lymphoscintigraphy detected at least one SLN in 369 out of the 391 procedures (94.4%). SLNs were found in the axillary chain in 367 cases and in the internal mammary chain in 55. In two of these 55 cases (3.6%), the SLN was the only one detected. There was no drainage to the internal mammary chain in any case of subdermal injection but such drainage was found in 15.9% of cases with peritumoural injection and 17.6% of those with intratumoural injection. Compared with tumours located in the outer quadrants, a higher percentage of tumours located in the inner quadrants showed drainage to the internal mammary chain (p<0.001). A total of 42 SLNs in the internal mammary chain could be removed in 32 patients without appreciable morbidity. In 20 cases both axillary and internal mammary SLNs were negative, in four both were positive, and in five axillary SLNs were positive and internal mammary SLNs were negative. More interestingly, in the remaining patient with both axillary and internal mammary SLNs, the axillary SLN was negative while malignant cells were found in the internal mammary region. In the evaluation of the clinical impact of internal mammary SLN biopsy, we found that staging was modified from pN1a to pN1c in four patients and, more importantly, from pN0 to pN0(i+) in one patient. The change in stage led to a modification of the postoperative treatment plan with respect to radiotherapy and systemic therapy.

Conclusion

Evaluation of the SLNs in the internal mammary chain provides more accurate staging of breast cancer patients. If internal mammary sampling is not performed, patients can be understaged. This technique can offer a better indication of those patients who will benefit from selective treatment options like radiotherapy to this region or systemic therapy.

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

Similar content being viewed by others

References

  1. Reintgen D, Cruse CW, Wells K, Berman C, Fenske N, Glass F, et al. The orderly progression of melanoma nodal metastases. Ann Surg 1994;6:759–67

    Article  Google Scholar 

  2. Aarsvold JN, Alazraki NP. Update on detection of sentinel lymph nodes in patients with breast cancer. Semin Nucl Med 2005;35:116–28

    Article  PubMed  Google Scholar 

  3. Veronesi U, Cascinelli N, Bufalino R, Morabito A, Greco M, Galluzzo D, et al. Risk of internal mammary lymph nodes metastases and its relevance on prognosis of breast cancer patients. Ann Surg 1983;198:681–4

    Article  CAS  PubMed  Google Scholar 

  4. Freedman GM, Fowble BL, Nicolaou N, Sigurdson ER, Torosian MH, Boraas MC, et al. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys 2000;46:805–14

    Article  CAS  PubMed  Google Scholar 

  5. Farrús B, Vidal-Sicart S, Velasco M, Zanón G, Fernández PL, Muñoz M, et al. Incidence of internal mammary node metastases after a sentinel lymph node technique in breast cancer and its implication in the radiotherapy plan. Int J Radiat Oncol Biol Phys 2004;60:715–21

    Article  PubMed  Google Scholar 

  6. Allweis TM, Badriyyah M, Bar Ad V, Cohen T, Freund HR. Current controversies in sentinel lymph node biopsy for breast cancer. Breast 2003;12:163–71

    Article  CAS  PubMed  Google Scholar 

  7. Noguchi M, Tsugawa K, Miwa K. Internal mammary chain sentinel lymph node identification in breast cancer. J Surg Oncol 2000;73:75–80

    Article  CAS  PubMed  Google Scholar 

  8. Johnson N, Soot L, Nelson J, Franzini D, Vea H, Gruner S, et al. Sentinel node biopsy and internal mammary lymphatic mapping in breast cancer. Am J Surg 2000;179:386–8

    Article  CAS  PubMed  Google Scholar 

  9. Estourgie S, Nieweg OE, Valdés Olmos RA, Rutgers EJ, Kroon BBR. Lymphatic drainage patterns from the breast. Ann Surg 2004;239:232–7

    Article  PubMed  Google Scholar 

  10. Galimberti V, Veronesi P, Arnone P, De Cicco C, Renne G, Intra M, et al. Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol 2002;9:924–8

    Article  PubMed  Google Scholar 

  11. Paganelli G, Galimberti V, Trifiro G, Travaini L, De Cicco C, Mazzarol G, et al. Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 2002;46:138–44

    CAS  PubMed  Google Scholar 

  12. Uren RF, Howman-Giles R, Chung D, Thompson JF. Nuclear medicine aspects of melanoma and breast lymphatic mapping. Semin Oncol 2004;31:338–48

    Article  PubMed  Google Scholar 

  13. Nieweg O, Estourgie S, van Rijk M, Kroon B. Rationale for superficial injection techniques in lymphatic mapping in breast cancer patients. J Surg Oncol 2004;87:153–6

    Article  PubMed  Google Scholar 

  14. Ortega M, Vidal-Sicart S, Zanón G, Pahisa J, Santamaria G, Velasco M, et al. Comparative study of the different radiotracer administration route to locate the sentinel node in breast cancer. Rev Esp Med Nucl 2004;23:153–61

    CAS  PubMed  Google Scholar 

  15. Tanis P, Nieweg OE, Valdés Olmos RA, Kroon BBR. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg 2001;192:399–409

    Article  CAS  PubMed  Google Scholar 

  16. Jakub JW, Cox CE, Pipas AW, Gardner M, Pendas S, Reintgen DS. Controversial topics in breast lymphatic mapping. Semin Oncol 2004;31:324–32

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Montgomery LL , Thorne AC, Van Zee KJ, Fey J, Heerdt AS, Gemignani M, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg 2002;95:385–8

    PubMed  Google Scholar 

  19. Simmons R, Thevarajah S, Brennan MB, Christos P, Osborne M. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Ann Surg Oncol 2003;10:242–7

    Article  PubMed  Google Scholar 

  20. Cserni G, Szekeres JP. Internal mammary lymph nodes and sentinel node biopsy in breast cancer. Surg Oncol 2001;10:25–33

    Article  CAS  PubMed  Google Scholar 

  21. Benamor M, Nos C, Fréneaux P, Clough KB. Impact of internal mammary sentinel node imaging in breast cancer. Clin Nucl Med 2002;28:375–8

    Google Scholar 

Download references

Acknowledgements

This work was supported in part by Instituto de Salud Carlos III, Red Temática del Cáncer no. C03/10.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine (CDI), Hospital Clínic, University of Barcelona, Barcelona, Spain

    Pilar Paredes, Sergi Vidal-Sicart, Jaime Ortín, Joan Duch & Francesca Pons

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Sergi Vidal-Sicart, Pedro Luís Fernández, Martín Velasco, Gorane Santamaría & Francesca Pons

  3. Department of Gynaecology (ICGON), Hospital Clínic, Barcelona, Spain

    Gabriel Zanón & Jaume Pahisa

  4. Department of Pathology (CDB), Hospital Clínic, Barcelona, Spain

    Pedro Luís Fernández

  5. Department of Radiology (CDI), Hospital Clínic, Barcelona, Spain

    Martín Velasco & Gorane Santamaría

Authors
  1. Pilar Paredes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergi Vidal-Sicart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel Zanón
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaume Pahisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pedro Luís Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martín Velasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gorane Santamaría
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jaime Ortín
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joan Duch
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesca Pons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pilar Paredes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paredes, P., Vidal-Sicart, S., Zanón, G. et al. Clinical relevance of sentinel lymph nodes in the internal mammary chain in breast cancer patients. Eur J Nucl Med Mol Imaging 32, 1283–1287 (2005). https://doi.org/10.1007/s00259-005-1867-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-005-1867-z

Keywords

Search

Navigation