Internal Mammary Sentinel Lymph Nodes in Breast Cancer - Effects on Disease Prognosis and Therapeutic Protocols - A Case Report

Abstract

BACKGROUND:The main prognostic factor in early staged breast cancer is the axillary lymph node metastatic affection. Sentinel lymph node biopsy, as a staging modality, significantly decreases surgical morbidity. The status of internal mammary lymph nodes gains an increased predictive role in grading breast carcinomas and modulation of postoperative therapeutic protocols. If positive, almost always are associated with worse disease outcome. Nevertheless, the clinical significance of internal mammary lymph node micrometastases has not been up to date precisely defined.AIM:To present a case of female patient clinically diagnosed as T1, N0, M0 (clinical TNM) ductal breast carcinoma with scintigraphic detection of internal mammary and axillary sentinel lymph nodes.METHODS:Dual method of scintigraphic sentinel lymph node detection using 99mTc-SENTI-SCINT and blue dye injection, intraoperative gamma probe detection, radioguided surgery and intraoperative ex tempore biopsy were used.CASE REPORT:We present a case of clinically T1, N0, M0 ductal breast cancer with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. Intraoperative ex tempore biopsy revealed micrometastases in the internal mammary node and no metastatic involvement of the axillary sentinel lymph node.CONCLUSION:Detection of internal mammary lymph node metastases improves N (nodal) grading of breast cancer by selecting a high risk subgroup of patients that require adjuvant hormone therapy, chemotherapy and/or radiotherapy.

Outcomes of Patients With Breast Cancer Treated With or Without Internal Mammary Irradiation: A Single-Center, Retrospective Propensity Score–Matched Study

“…The internal mammary lymph nodes are of concern because they are hypothesized to be a core area for micrometastases [4] , increasing the risk of distant metastases in the future.…”

“…The internal mammary lymph nodes are of concern because they are hypothesized to be a core area for micrometastases, 4 increasing the risk of distant metastases in the future. However, irradiation of the internal mammary lymph nodes inevitably increases the dose to the lung and heart.…”