Utility of Internal Mammary Lymph Node Removal When Noted by Intraoperative Gamma Probe Detection

“…4,5 In addition, the presence of IMC metastases depends on tumor location in the breast, with a higher prevalence of IMC metastases in tumors of the inner quadrants, especially the lower-inner quadrant. [6][7][8] The IMC is not routinely investigated for the presence of lymph node metastases, and breast cancer is classified as lymph node negative on the basis of axillary lymph node investigations only. Undetected IMC metastases, therefore, lead to under-staging of patients without axillary lymph node involvement and to under-treatment of stage I patients who have no indication of adjuvant chemotherapy.…”

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confidence: 99%

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

et al. 2006

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Background: There is growing evidence that tumors of the inner quadrants (especially the lower-inner quadrant) metastasize more often to the internal mammary chain (IMC). As these metastases are not investigated, patients with lower-inner quadrant tumors have an increased risk of being under-staged and under-treated and may therefore have a higher risk of death from breast cancer.Methods: We identified all 1522 women operated for stage I breast cancer between 1984 and 2002 recorded at the population-based Geneva Cancer Registry. We compared breast cancer mortality risk by tumor location with multivariate Cox regression analysis that accounted for all factors linked to tumor location and survival.Results: Ten-year disease-specific survival was 93% (95%CI: 91-94%). Patients with breast cancer of the lower-inner quadrant (n = 118; 7.8%) had an importantly increased risk of dying of breast cancer compared to women with breast cancer of the upper-outer quadrant (multiadjusted Hazard Ratio: 2.3, 95%CI: 1.1-4.5, P = 0.0206). The over-mortality associated with this quadrant was particularly evident for tumors >10 mm (multiadjusted HR: 3.6, 95%CI: 1.6-7.9, P = 0.0016). There was no increased breast cancer mortality risk for tumors located in other quadrants.Conclusions: Tumor location in the lower-inner quadrant is an independent and important prognostic factor of stage I breast cancer. Further research is needed to evaluate if the overmortality of patients with stage I cancer of the lower-inner quadrant is indeed a result of under-treatment due to undetected IMC metastases. If so, patients with stage I breast cancer of the lower-inner quadrant are good candidates for systematic IMC investigation.

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“…With recent studies citing the low morbidity associated with extra-axillary, specifically internal mammary, sentinel lymph node biopsy, the question of whether extra-axillary SLNB should be performed has been raised by many authors. 34-36 Veronesi and others have shown that IM lymph node involvement confers a poorer prognosis and shorter survival. 37 The 2006 revisions to the American Joint Committee on Cancer staging manual reflect the importance of IM nodes in breast cancer staging.…”

Section: Discussionmentioning

confidence: 99%

Intra-Individual Comparison of Lymphatic Drainage Patterns Using Subareolar and Peritumoral Isotope Injection for Breast Cancer

et al. 2009

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Background Controversy exists in the literature regarding the optimal site for lymphatic mapping in breast cancer. This study was designed to characterize lymphatic drainage patterns within the same patient after subareolar (SA) and peritumoral (PT) radiopharmaceutical injections and examine the impact of reader interpretation on reported drainage. Methods In this prospective trial, 27 women with breast cancer underwent sequential preoperative SA and PT injections of 0.5 to 2.7 mCi of technetium-99 m filtered sulfur colloid 3 days or more apart. Patterns of radiopharmaceutical uptake were reviewed independently by two nuclear medicine physicians. Inter-reader agreement and injection success were assessed in conjunction with observed drainage patterns. Results There was near perfect inter-reader agreement observed on identification of axillary LN drainage after PT injection (P = 0.0004) and substantial agreement with SA injection (P = 0.0344). SA injection was more likely to drain to only axillary LNs, whereas PT injection appeared more likely to drain to both axillary and extra-axillary LNs, although no statistically significant differences were found. All patients with extra-axillary drainage after PT injection (n = 6 patients) had only axillary drainage after SA injection. Dual drainage was observed for six patients with PT injection and one patient with SA injection. Conclusions Our findings suggest that radiopharmaceutical injected in the SA location has a high propensity to drain to axillary LNs only. After controlling for patient factors and demonstrating inter-reader agreement, the inability to demonstrate statistically significant differences in drainage based on injection site suggests that lymphatic drainage patterns may be a function of patient and tumorspecific features.

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Utility of Internal Mammary Lymph Node Removal When Noted by Intraoperative Gamma Probe Detection

Abstract: Radioguided SLN detection should be attempted in the IMN basin with all tumors. If an IMN is identified, it should be removed. IMN biopsy is a feasible, low-risk procedure when directed by radioguided LM and provides a guide for radiotherapy for patients with positive IMNs.

Cited by 38 publications

References 15 publications

Lymphatic Drainage Patterns From the Breast

Lymphatic Drainage Patterns From the Breast

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

Intra-Individual Comparison of Lymphatic Drainage Patterns Using Subareolar and Peritumoral Isotope Injection for Breast Cancer

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