Internal Mammary Sentinel Lymph Node Biopsy: Minimally Invasive Staging and Tailored Internal Mammary Radiotherapy

Excerpt

Internal mammary lymph node (IMLN) metastasis has a similar prognostic importance as axillary lymph nodal involvement in breast cancer patients. Even though TNM staging has incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept since the 6th edition of the American Joint Committee on Cancer, IM-SLNB has not been performed routinely and has remained a subject of discussion. In fact, accurate staging could not be achieved by depending on the status of the axillary sentinel lymph node alone, which might lead to under-stage and under-treatment. The recent studies of Caudle et al.1 and Gnerlich et al.2 showed again that IM-SLNB was a minimally invasive technique for the efficient evaluation of the status of internal mammary sentinel lymph nodes (IM-SLN) with high safety and feasibility. Gnerlich et al.2 reported no complications in their study, and Caudle et al.1 found only two intraoperative surgical complications, but both were resolved smoothly. In our current study, there is no pneumothorax on postoperative chest radiography and no postoperative bleeding. IM-SLNB had made a more accurate lymph node staging and improved the decision making of the adjuvant radiotherapy of the IMLN, and even adjuvant systemic therapy in some cases. …