Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2,269 Chinese breast cancer patients treated with extended radical mastectomy

Huang, Ou; Wang, Liping; Shen, Kunwei; Lin, Hong; Hu, Zhen; Li, Guangyu; Wu, Jiong; Lu, Jinsong; Shao, Zhi‐Ming; Han, Qixia; Shen, Zhenzhou

doi:10.1007/s10549-007-9561-4

Cited by 123 publications

(87 citation statements)

References 7 publications

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“…29 On the assumption that the IMC incidental irradiation has a therapeutic impact, an interesting note is that precisely the group that received the higher doses to the IMC comprises mastectomy patients, regardless of whether an immediate reconstruction was performed or not. These patients usually have more advanced disease, which might translate into a higher risk of relapse at the IMC, 30 and would so benefit from this approach. On the other hand, patients with multiple positive lymph nodes and undergoing conservative surgery, although with significant risk of regional recurrence, would be receiving reduced unintended radiation doses in the IMC, requiring, therefore, a regional approach with more extensive irradiation.…”

Section: Discussionmentioning

confidence: 99%

Unintended irradiation of internal mammary chain – Is that enough?

Sapienza

Chen

Gomes

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Section: Discussionmentioning

confidence: 99%

Unintended irradiation of internal mammary chain – Is that enough?

Sapienza

Chen

Gomes

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…1 Surgical studies have shown that the incidence of metastatic involvement of the internal mammary nodes varies between 4% and 9% in patients with axillary node-negative breast cancer and between 16% and 65% in patients with axillary node-positive breast cancer. [2][3][4] As a consequence, surgical dissection of the internal mammary nodes was attempted but abandoned in the 1970s, since no improvement in survival was observed. 4,5 Elective irradiation of the regional nodes remained widely used until the late 1980s, when it became less popular on the basis of an overview of older trials that showed no survival benefit, despite improvement in control of locoregional disease.…”

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confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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“…In which, breast cancer drainage to internal mammary node (IMN) happens in as many as 30% of patients [21,22] . Most of IMN metastases have concomitant axillary metastases, but 8%-10% patients with breast cancer may have IMN metastases only [23] .…”

Section: Fdg Pet/ct For Internal Mammary Lymph Nodesmentioning

confidence: 99%

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Liu¹

2014

WJCO

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Fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Fluorodeoxyglucose positron emission tomography/computed tomography; Locoregional nodal disease; Axillary lymph node; Internal mammary lymph node; Axillary lymph node dissection; Sentinel lymph node biopsy Core tip: The presence and extent of locoregional nodal metastasis at diagnosis is the single most important prognostic factor in breast cancer. The predominant lymphatic drainage pathway from the breast cancer is toward the axilla. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity secondary to the limitation of its spatial resolution. The internal mammary node (IMN) involvement is of prognostic significance in breast cancer, and IMN metastasis has been associated with higher rate of distant metastasis and lower overall survival rates. Limited preliminary data indicated that FDG PET/CT plays a role in identification of positive IMN, and it is superior to conventional imaging modalities.

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Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2,269 Chinese breast cancer patients treated with extended radical mastectomy

Cited by 123 publications

References 7 publications

Unintended irradiation of internal mammary chain – Is that enough?

Unintended irradiation of internal mammary chain – Is that enough?

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

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