Medial Tumor Localization in Breast Cancer – an Unappreciated Risk Factor?

Bräutigam, E.; Track, C.; Seewald, D.H.; Feichtinger, J.; Spiegl, K.J.; Hammer, J.

doi:10.1007/s00066-009-1984-x

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…Several studies reported that prognosis of patients with medially located tumors is inferior to that of patients with laterally located tumors [17, 18]. Since it is known that medial tumors more often drain to the IMC, the rationale for harvesting IMC SLNs is the assumption that the poorer prognosis of patients with medially located tumors is a result of understaging of IMC lymph node metastases with the consequence of omitting adjuvant treatment in this patient group [11, 19, 20].…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy of the internal mammary chain in breast cancer

Postma

Wieringen

Hobbelink

et al. 2012

Breast Cancer Res Treat

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Routine removal of the internal mammary chain (IMC) sentinel node in breast cancer patients remains a subject of discussion. The aim of this study was to determine the impact of routinely performed IMC sentinel node biopsy on the systemic and locoregional treatments plan. All patients with biopsy proven breast cancer who underwent a sentinel node procedure between 2002 and 2011 were included in a prospective database. In cases of IMC drainage, successful exploration of the IMC (i.e., sentinel node removed) and surgical complications were registered. If the removed sentinel node contained malignant cells we determined if this altered the treatment plan when practising the current guidelines. In total, 119 of the 493 included patients showed IMC drainage on lymphoscintigraphy. Exploration of the IMC was performed in 107 (89 %) patients; in 86/107 (80 %) exploration was successful. In 14/107 patients (13 %) the IMC sentinel node was tumor positive. Macro and micro metastases were found in eight and six patients, respectively. In the group of patients who underwent surgical exploration of the IMC, systemic treatment was changed in none, radiotherapy treatment in 13/107 patients (11 %). Routine sentinel node biopsy of the IMC does not alter the systemic treatment. Radiotherapy treatment is altered in a small proportion of the patients; however, solid scientific evidence for this adjustment is lacking.

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Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy of the internal mammary chain in breast cancer

Postma

Wieringen

Hobbelink

et al. 2012

Breast Cancer Res Treat

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“…In addition, according to several studies with respect to tumor location as a prognostic factor, inner quadrant tumors showed higher distant metastases and lower OS rates than those shown by outer quadrant tumors [678]. …”

Section: Discussionmentioning

confidence: 99%

“…However, the prognostic role of tumor location has not been evaluated in breast cancer patients who underwent NAC. According to previous reports, in patients with breast cancer, a tumor in the inner/both quadrants has long been regarded as a worse prognostic factor for survival than a tumor in the outer quadrant [5678]. …”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

et al. 2016

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PurposeIn the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC).MethodsBetween March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months.ResultsThe 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures.ConclusionAmong breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.

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“…The predictive factor for internal mammary chain drainage was location of the tumors in the inner quadrants (P<0.001). There are also data supporting the negative prognostic value of location of tumor in the inner quadrant [41][42] . This difference may be explained by lymph drainage to internal mammary nodes which are usually omitted during breast cancer patient staging and treatment.…”

Section: Management Of Imn and Impact On Disease-free And Overall Patmentioning

confidence: 91%

Internal mammary node management in breast cancer. A review

Vrána¹,

Gatěk²,

Cwiertka³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed.

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Medial Tumor Localization in Breast Cancer – an Unappreciated Risk Factor?

Abstract: Medial tumor location is associated with a lower survival rate, but not with inferior local tumor control. Failure to identify nodal metastases confined to the internal mammary chain may lead to undertreatment with systemic/local agents and compromised survival.

Cited by 12 publications

References 35 publications

Sentinel lymph node biopsy of the internal mammary chain in breast cancer

Sentinel lymph node biopsy of the internal mammary chain in breast cancer

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

Internal mammary node management in breast cancer. A review

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