Top

Published in:

01-10-2015 | Clinical trial

The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients

Authors: Xiaofei Zhang, Shabnam Jaffer, Ira J. Bleiweiss, Anupma Nayak

Published in: Breast Cancer Research and Treatment | Issue 3/2015

Abstract

The clinical significance of IMLN metastases in breast cancer is controversial. Although IMLN status is an integral part of current AJCC staging of breast cancer, the elective sampling of IMLN is not part of routine surgery for breast cancer. The purpose of this study was to determine the incidence of IMLN metastases, associated risk factors if any, and its impact on further management and outcome. We retrospectively studied 470 cases that underwent autologous reconstruction surgery between 2002 and 2014. Of 470 cases, 157 breast cancer cases had histology-confirmed IMLN removal during the reconstruction. Only 9 patients (6 %) showed IMLN metastases as compared to 45 (34 %) that showed axillary nodal metastases (p < 0.01). Interestingly, 4 patients had metastases limited to IMLN without any metastases to axillary nodes. IMLN metastasis was significantly associated with age <40 years, lymphovascular invasion, and negative PR status. IMLN metastasis resulted in upstaging of 2 patients from stage I to III, and 1 from stage II to III. Five patients received additional chest wall radiation to target the positive IMLNs. Nine of 157 (6 %) patients with IMLN removal during reconstruction had loco-regional recurrence/metastasis as compared to 20 of 293 (7 %) patients without IMLN removal (p > 0.05) (follow-up, 1–134 months). The overall rate of IMLN metastases (6 %) is much lower than the rate of axillary node metastases. Selective biopsy of IMLNs in patients with breast cancer, especially if younger than 40 years, and with lymphovascular invasion and negative PR status, may guide adjuvant treatment.

Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582CrossRefPubMed

Bass SS, Lyman GH, McCann CR et al (1999) Lymphatic mapping and sentinel lymph node biopsy. Breast J 5:288–295CrossRefPubMed

Lamonica D, Edge SB, Hurd T, Proulx G, Stomper PC (2003) Mammographic and clinical predictors of drainage patterns in breast lymphoscintigrams obtained during sentinel node procedures. Clin Nucl Med 28:558–564CrossRefPubMed

Estourgie SH, Nieweg OE, Olmos RA et al (2004) Lymphatic drainage patterns from the breast. Ann Surg 239:232–237PubMedCentralCrossRefPubMed

Lacour J, Bucalossi P, Cacers E et al (1976) Radical mastectomy versus radical mastectomy plus internal mammary dissection: five-year results of an international cooperative study. Cancer 37:206–214CrossRefPubMed

Lacour J, Le M, Caceres E, Koszarowski T, Veronesi U, Hill C (1983) Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten-year results of an international cooperative trial in breast cancer. Cancer 51:1941–1943CrossRefPubMed

Veronesi U, Cascinelli N, Greco M et al (1985) Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 202:702–707PubMedCentralCrossRefPubMed

Donegan WL (1977) The influence of untreated internal mammary metastases upon the course of mammary cancer. Cancer 39:533–538CrossRefPubMed

Livingston SF, Arlen M (1974) The extended extrapleural radical mastectomy: its role in the treatment of carcinoma of the breast. Ann Surg 179:260–265PubMedCentralCrossRefPubMed

10.

Dahl-Iversen E, Tobiassen T (1969) Radical mastectomy with parasternal and supraclavicular dissection for mammary carcinoma. Ann Surg 170:889–891PubMedCentralCrossRefPubMed

11.

Urban JA (1978) Management of operable breast cancer: the surgeon’s view. Cancer 42:2066–2077CrossRefPubMed

12.

Cody HS 3rd, Urban JA (1995) Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol 2:32–37CrossRefPubMed

13.

Sohn VY, Arthurs ZM, Sebesta JA, Brown TA (2008) Primary tumor location impacts breast cancer survival. Am J Surg 195:641–644CrossRefPubMed

14.

Colleoni M, Zahrieh D, Gelber RD et al (2005) Site of primary tumor has a prognostic role in operable breast cancer: the international breast cancer study group experience. J Clin Oncol 23:1390–1400CrossRefPubMed

15.

AJCC Cancer Staging Handbook (2009) New York: Springer

16.

Jansen L, Doting MH, Rutgers EJ et al (2000) Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer. Br J Surg 87:920–925CrossRefPubMed

17.

Johnson N, Soot L, Nelson J et al (2000) Sentinel node biopsy and internal mammary lymphatic mapping in breast cancer. Am J Surg 179:386–388CrossRefPubMed

18.

van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG (2001) Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 234:79–84PubMedCentralCrossRefPubMed

19.

Sugg SL, Ferguson DJ, Posner MC, Heimann R (2000) Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol 7:188–192CrossRefPubMed

20.

Dupont E, Cox CE, Nguyen K et al (2001) Utility of internal mammary lymph node removal when noted by intraoperative gamma probe detection. Ann Surg Oncol 8:833–836CrossRefPubMed

21.

Paganelli G, Galimberti V, Trifirò G et al (2002) Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 46:138–144PubMed

22.

Tanis PJ, Nieweg OE, Valdés Olmos RA et al (2002) Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer 87:705–710PubMedCentralCrossRefPubMed

23.

Estourgie SH, Tanis PJ, Nieweg OE et al (2003) Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients. Ann Surg Oncol 10:935–941CrossRefPubMed

24.

Paredes P, Vidal-Sicart S, Zanon G et al (2005) Clinical relevance of sentinel lymph nodes in the internal mammary chain in breast cancer patients. Eur J Nucl Med Mol Imaging 32:1283–1287CrossRefPubMed

25.

Hong J, Choy E, Soni N et al (2005) Extra-axillary sentinel node biopsy in the management of early breast cancer. Eur J Surg Oncol 31:942–948CrossRefPubMed

26.

Leidenius MH, Krogerus LA, Toivonen TS, Leppanen EA, von Smitten KA (2006) The clinical value of parasternal sentinel node biopsy in breast cancer. Ann Surg Oncol 13:321–326CrossRefPubMed

27.

Madsen E, Gobardhan P, Bongers V et al (2007) The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 14:1486–1492PubMedCentralCrossRefPubMed

28.

Coombs NJ, Boyages J, French JR, Ung OA (2009) Internal mammary sentinel nodes: ignore, irradiate or operate? Eur J Cancer 45:789–794CrossRefPubMed

29.

Long H, Lin Z, Situ D, Ma G, Zheng Y, Rong T (2011) Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients. Breast 20:129–133CrossRefPubMed

30.

Postma EL, Van Wieringen S, Hobbelink MG, Verkooijen HM, Van den Bongard HJGD, Borel Rinkes IHM (2012) Sentinel lymph node biopsy of the internal mammary chain in breast cancer. Breast Cancer Res Treat 134:735–741PubMedCentralCrossRefPubMed

31.

Kim H, Shin MJ, Kim SJ, Kim IJ, Park I (2014) The relation of visualization of internal mammary lymph nodes on lymphoscintigraphy to axillary lymph node metastases in breast cancer. Lymphat Res Biol 12:295–300CrossRefPubMed

32.

Qiu PF, Liu JJ, Liu YB, Yang GR, Sun X, Wang YS (2012) A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in breast cancer patients. Breast Cancer Res Treat 136:319–321CrossRefPubMed

33.

Caudle AS, Yi M, Hoffman KE, Mittendorf EA, Babiera GV, Hwang RF, Meric-Bernstam F, Sahin AA, Hunt KK (2014) Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients. Ann Surg Oncol 21:60–65CrossRefPubMed

34.

Heuts EM, van der Ent FW, Hulsewe KW, von Meyenfeldt MF, Voogd AC (2009) Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases. Breast 18:254–258CrossRefPubMed

35.

Hennequin C, Bossard N, Servagi-Vernat S et al (2013) Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys 86:860–866CrossRefPubMed

36.

Thorsen LB, Thomsen MS, Berg M et al (2014) Danish Breast Cancer Cooperative Group Radiotherapy committee. CT-planned internal mammary node radiotherapy in the DBCG-IMN study: benefit versus potentially harmful effects. Acta Oncol 53:1027–1034CrossRefPubMed

37.

Schaverien MV, Purdie CA, Munnoch DA (2013) Clinical value of internal mammary lymph node metastases found incidentally during free flap recipient vessel exposure. Eur J Surg Oncol 39:608–612CrossRefPubMed

38.

Handley RS, Thackray AC (1954) Invasion of internal mammary lymph nodes in carcinoma of the breast. Br Med J 1:61–63PubMedCentralCrossRefPubMed

39.

Hutchinson WB, Kiriluk LB (1956) Internal mammary node investigation in carcinoma of the breast. Am J Surg 92:151–155CrossRefPubMed

40.

Caceres E (1959) Incidence of metastasis in the internal mammary chain in operable cancer of the breast. Surg Gynecol Obstet 108:715–720PubMed

41.

Bucalossi P, Veronesi U, Zingo L, Cantu C (1971) Enlarged mastectomy for breast cancer. Review of 1,213 cases. Am J Roentgenol Radium Ther Nucl Med 111:119–122CrossRefPubMed

42.

Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR (2008) Internal mammary nodes in breast cancer: diagnosis and implications for patient management: a systematic review. J Clin Oncol 26:4981–4989CrossRefPubMed

43.

Li Z, Gu X, Tong J, Liu B, Sun L, Gao X, Jiang X (2013) A meta-analysis of internal mammary lymph node metastasis in breast cancer patients. Onkologie 36:747–752CrossRefPubMed

44.

Andree C, Schmidt VJ, Munder BI et al (2012) Detecting of breast cancer metastasis by means of regional lymph node sampling during autologous breast reconstruction—a screening of 519 consecutive patients. Med Sci Monit 18:605–610

45.

Fischer JP, Nelson JA, Au A, Tuggle CT 3rd, Serletti JM, Wu LC (2014) Complications and morbidity following breast reconstruction–a review of 16,063 cases from the 2005–2010 NSQIP datasets. J Plast Surg Hand Surg 48:104–114CrossRefPubMed

46.

Yi Ann, Kim Hak Hee, Shin Hee Jung, Huh Mi Ock, Ahn Seung Do, Seo Bo Kyeong (2009) Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean J Radiol 10:496–507PubMedCentralCrossRefPubMed

47.

Hennequin C, Romestaing P, Maylin C (2008) Irradiation of lymph nodes areas in breast cancer. Cancer Radiother 12:559–564CrossRefPubMed

48.

Jin Jian-Yue, Klein Eric E, Kong Feng-Ming, Li Zuofeng (2005) An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers. J Appl Clin Med Phys 6:84–93CrossRefPubMed

49.

Galimberti V, Veronesi P, Arnone P et al (2002) Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol 9:924–928CrossRefPubMed

50.

Zeng J, Xie H, Lu Y, Feng Z, Li F (2012) Clinical implications of micro metastasis detection in internal mammary nodes of breast cancer patients. Breast Care (Basel) 7:216–219CrossRef

51.

Huang O, Wang L, Shen K et al (2008) 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 107:379–387CrossRefPubMed

Title: The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients
Authors: Xiaofei Zhang
Shabnam Jaffer
Ira J. Bleiweiss
Anupma Nayak
Publication date: 01-10-2015
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2015
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-015-3569-y

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2015

Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes: a nationwide study

Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer

Exogenous normal mammary epithelial mitochondria suppress glycolytic metabolism and glucose uptake of human breast cancer cells

Stratifying triple-negative breast cancer prognosis using 18F-FDG-PET/CT imaging

Paired-like Homeodomain Transcription factor 2 expression by breast cancer bone marrow disseminated tumor cells is associated with early recurrent disease development

Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer