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Accurate Staging with Internal Mammary Chain Sentinel Node Biopsy for Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although internal mammary chain (IMC) metastases are an independent predictor of prognosis, collecting IMC sentinel nodes (SN) remains controversial. We sought to determine predictors for IMC nodal positivity and the role positive IMC-SNs have on changing staging and management.

Methods

We reviewed a prospectively collected database (1997–2012) to identify patients who had IMC drainage detected on lymphoscintigraphy and underwent biopsy. Chi square tests and logistic regression models were used to determine trends and factors associated with IMC node positivity.

Results

A total of 122 patients with cTis–T2cN0M0 breast cancer underwent IMC-SN biopsy. Mean age of the cohort was 53 years, and mean tumor size was 2.0 cm. Identification of IMC nodes was successful in 100 % of the cases. There were no complications. Sentinel nodes mapped to the IMC alone in 14 of 122 (11 %) patients. Overall, 26 % of patients were node positive, with 12 of 122 (10 %) patients having a positive IMC-SN. In patients with a positive axilla, IMC-SN was positive in 33 % of patients, whereas in patients with a negative axilla, IMC-SN was positive in 3 % of cases (P < 0.001). The number of positive axillary nodes was the only independent predictor of IMC positivity (1–3 positive axillary nodes odds ratio 16.9, 95 % CI 3.1–91.1; ≥4 positive axillary nodes odds ratio 45.0, 95 % CI 4.0–500.7). IMC-SN positivity led to a more advanced nodal category in all patients and more accurate staging in 4 of 12 (33 %) patients.

Conclusions

IMC-SN biopsy is predictable and safe. Identification of IMC metastases though IMC-SN biopsy has the potential to alter the stage and adjuvant therapy of breast cancer patients.

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References

  1. Hultborn KA, Larsson LG, Ragnhult I. The lymph drainage from the breast to the axillary and parasternal lymph nodes, studied with the aid of colloidal Au198. Acta Radiol. 1955;43:52–64.

    Article  CAS  PubMed  Google Scholar 

  2. Turner-Warwick RT. The lymphatics of the breast. Br J Surg. 1959;46:574–82.

    Article  CAS  PubMed  Google Scholar 

  3. Blumgart EI, Uren RF, Nielsen PM, Nash MP, Reynolds HM. Predicting lymphatic drainage patterns and primary tumour location in patients with breast cancer. Breast Cancer Res Treat. 2011;130:699–705.

    Article  PubMed  Google Scholar 

  4. Hindie E, Groheux D, Hennequin C, et al. Lymphoscintigraphy can select breast cancer patients for internal mammary chain radiotherapy. Int J Radiat Oncol Biol Phys. 2009;83:1081–8.

    Article  Google Scholar 

  5. Carcoforo P, Basaglia E, Soliani G, et al. Sentinel node biopsy in the evaluation of the internal mammary node chain in patients with breast cancer. Tumori. 2002;88:S5–7.

    CAS  PubMed  Google Scholar 

  6. van der Ent FW, Kengen RA, van der 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 

  7. Heuts EM, van der Ent FW, von Meyenfeldt MF, Voogd AC. Internal mammary lymph drainage and sentinel node biopsy in breast cancer—a study on 1008 patients. Eur J Surg Oncol. 2009;35:252–7.

    Article  CAS  PubMed  Google Scholar 

  8. Estourgie SH, Tanis PJ, Nieweg OE, Valdes Olmos RA, Rutgers EJ, Kroon BB. Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients. Ann Surg Oncol. 2003;10:935–41.

    Article  PubMed  Google Scholar 

  9. Farrus B, Vidal-Sicart S, Velasco 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 

  10. Veronesi U, Cascinelli N, Bufalino R, et al. Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg. 1983;198:681–4.

    Article  CAS  PubMed  Google Scholar 

  11. Sugg SL, Ferguson DJ, Posner MC, Heimann R. Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol. 2000;7:188–92.

    Article  CAS  PubMed  Google Scholar 

  12. Cody HS 3rd, Urban JA. Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol. 1995;2:32–7.

    Article  PubMed  Google Scholar 

  13. 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 

  14. Morrow M, Foster RS Jr. Staging of breast cancer: a new rationale for internal mammary node biopsy. Arch Surg. 1981;116:748–51.

    Article  CAS  PubMed  Google Scholar 

  15. Veronesi U, Cascinelli N, Greco M, et al. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg. 1985;202:702–7.

    Article  CAS  PubMed  Google Scholar 

  16. Noguchi M, Ohta N, Koyasaki N, Taniya T, Miyazaki I, Mizukami Y. Reappraisal of internal mammary node metastases as a prognostic factor in patients with breast cancer. Cancer. 1991;68:1918–25.

    Article  CAS  PubMed  Google Scholar 

  17. Noguchi M, Koyasaki N, Ohta N, et al. Internal mammary nodal status is a more reliable prognostic factor than DNA ploidy and c-erb B-2 expression in patients with breast cancer. Arch Surg. 1993;128:242–6.

    Article  CAS  PubMed  Google Scholar 

  18. American Joint Committee on Cancer. Breast. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 347–76.

    Chapter  Google Scholar 

  19. Galimberti V, Veronesi P, Arnone P, 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 

  20. Avisar E, Molina MA, Scarlata M, Moffat FL. Internal mammary sentinel node biopsy for breast cancer. Am J Surg. 2008;196:490–4.

    Article  PubMed  Google Scholar 

  21. Postma EL, van Wieringen S, Hobbelink MG, et al. Sentinel lymph node biopsy of the internal mammary chain in breast cancer. Breast Cancer Res Treat. 2012;134:735–41.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Huang O, Wang L, Shen K, et al. 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. Breast Cancer Res Treat. 2008;107:379–87.

    Article  PubMed  Google Scholar 

  23. Noguchi M, Ohta N, Thomas M, Kitagawa H, Miyazaki I. Risk of internal mammary lymph node metastases and its prognostic value in breast cancer patients. J Surg Oncol. 1993;52:26–30.

    Article  CAS  PubMed  Google Scholar 

  24. Madsen E, Gobardhan P, Bongers V, et al. The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol. 2007;14:1486–92.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Noguchi M, Taniya T, Koyasaki N, Miyazaki I. A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer. Int Surg. 1992;77:48–54.

    CAS  PubMed  Google Scholar 

  26. Cranenbroek S, van der Sangen MJ, Kuijt GP, Voogd AC. Diagnosis, treatment and prognosis of internal mammary lymph node recurrence in breast cancer patients. Breast Cancer Res Treat. 2005;89:271–5.

    PubMed  Google Scholar 

  27. Fowble B, Solin LJ, Schultz DJ, Goodman RL. Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer. Int J Radiat Oncol Biol Phys. 1989;17:703–10.

    Article  CAS  PubMed  Google Scholar 

  28. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1991;9:988–96.

    CAS  PubMed  Google Scholar 

  29. Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer. 1977;39(6 Suppl):2827–39.

    Article  CAS  PubMed  Google Scholar 

  30. Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27:2946–53.

    Article  PubMed  Google Scholar 

  31. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.

    PubMed  Google Scholar 

  32. Arriagada R, Le MG. Adjuvant radiotherapy in breast cancer—the treatment of lymph node areas. Acta Oncol. 2000;39:295–305.

    Article  CAS  PubMed  Google Scholar 

  33. Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR. Internal mammary nodes in breast cancer: diagnosis and implications for patient management—a systematic review. J Clin Oncol. 2008;26:4981–9.

    Article  PubMed  Google Scholar 

  34. Taghian A, Jagsi R, Makris A, et al. Results of a survey regarding irradiation of internal mammary chain in patients with breast cancer: practice is culture driven rather than evidence based. Int J Radiat Oncol Biol Phys. 2004;60:706–14.

    Article  PubMed  Google Scholar 

  35. Veronesi U, Arnone P, Veronesi P, et al. The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series. Ann Oncol. 2008;19:1553–60.

    Article  CAS  PubMed  Google Scholar 

  36. He Q, Zhuang D, Tian J, Zheng L, Fan Z, Li X. Surgical approach to internal mammary sentinel node biopsy. J Invest Surg. 2010;23:321–6.

    Article  PubMed  Google Scholar 

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Acknowledgment

This study was supported in part by the Butz Foundation.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Jennifer L. Gnerlich MD & J. Camilo Barreto-Andrade MD

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Tomasz Czechura MPH, Jeremy R. John BA, Mary A. Turk CTR, CCRP & David J. Winchester MD

  3. Montefiore-Einstein Medical Center, Bronx, NY, USA

    Timothy J. Kennedy MD

Authors
  1. Jennifer L. Gnerlich MD
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  2. J. Camilo Barreto-Andrade MD
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  3. Tomasz Czechura MPH
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  6. Timothy J. Kennedy MD
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Correspondence to David J. Winchester MD.

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Gnerlich, J.L., Barreto-Andrade, J.C., Czechura, T. et al. Accurate Staging with Internal Mammary Chain Sentinel Node Biopsy for Breast Cancer. Ann Surg Oncol 21, 368–374 (2014). https://doi.org/10.1245/s10434-013-3263-4

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  • DOI: https://doi.org/10.1245/s10434-013-3263-4

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