Chest wall resection for internal mammary lymph node metastases of breast cancer

Geel, Albertus N. van; Wouters, Michel W. J. M.; Pol, Carmen van der; Schmitz, Paul; Lans, Titia E.

doi:10.1016/j.breast.2009.01.005

Cited by 12 publications

(6 citation statements)

References 48 publications

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“…They found that MRI had a 90.7% accuracy, 93.3% sensitivity, and 89.3% specificity using size-based criterion (≥5 mm as positive). 10 These findings support our suggestion of using the size-criteria ≥5 mm in short axis; in fact, they suggest that we may be underestimating the incidence of pathological IMN in our population. By contrast, Eubank et al 14 only classified nodes greater than 11 mm in short axis on CT as pathological, referring to the nodal map of Naruke et al 15 This map was designed for staging lung cancer and may not be appropriate for breast cancer staging.…”

Section: Discussionsupporting

confidence: 89%

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Incidence and Potential Significance of Internal Mammary Lymphadenopathy on Computed Tomography in Patients with a Diagnosis of Primary Breast Cancer

Savaridas

Spratt

Cox

2015

Breast Cancer�(Auckl)

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INTRODUCTIONThe importance of internal mammary nodes (IMNs) in the staging and treatment of breast cancer patients is controversial.METHODSA retrospective cohort of patients diagnosed with primary breast cancer over a 4-year period (January 2009 to December 2012) was assessed. The number and size of any IMNs visible on spiral computed tomography (CT) were recorded.RESULTSA total of 830 patients were diagnosed with primary breast cancer within the identified time frame, of which 150 patients met the inclusion criteria. Of these 42% (63) had IMNs present, although the majority were small (<5 mm). However, 16% (25) had larger nodes, greater than 5 mm in short axis, present on CT. Significantly more patients with the presence of large (>5 mm) IMNs had more advanced disease with CT evidence of other distant spread.CONCLUSIONWe have demonstrated that IMNs are present in a substantial number of our primary breast cancer patients. We suggest that further histological research is required to establish reliable CT size criterion for pathological IMNs. In addition, routine imaging of the IM chain, as well as axilla, should be considered in the staging of breast cancer.

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Section: Discussionsupporting

confidence: 89%

“…Additional reports suggest that IMN metastases can be safely removed surgically. 9 , 10 Therefore, if it were possible to demonstrate the IMN involved with noninvasive imaging techniques, there are new treatment techniques that could be used with relatively low morbidity.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Potential Significance of Internal Mammary Lymphadenopathy on Computed Tomography in Patients with a Diagnosis of Primary Breast Cancer

Savaridas

Spratt

Cox

2015

Breast Cancer�(Auckl)

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“…Surgery is considered the cornerstone in isolated locoregional metastases as the effectiveness of chemotherapy and/or radiotherapy as a first line remains unclear. 32,33 In this study, one patient who previously underwent free MSTRAM for DBR and was proven to have an incidental positive IMLN required palliative CWR and reconstruction with sternal plates and pectoralis major muscle to control locoregional IMLN recurrence 2 years later. Observation from previously published reports demonstrated that proximate collaboration between several disciplines with a multidisciplinary thoracic oncoplastic approach is of paramount importance in devising a comprehensive and safe outcome for this challenging group of patients.…”

Section: Discussionmentioning

confidence: 95%

“…34,35 Few studies reported a strong relationship between tumor location and the lymphatic drainage, with medial tumors lymphatic drainage been higher to IMLN 1,34 ; however, it was not emphasized by other studies. 9,32 This has led to an ongoing debatable issue that patients with medially located tumors are understaged and receive inadequate oncological treat-ment. [36][37][38] It is worth noting that 88% (6/7) patients presented initially with medial tumors.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgically and Radiologically Detected Incidental Internal Mammary Lymph Node Enlargement in Breast Cancer Patients Undergoing Free-Flap Breast Reconstruction

Khalil

Kalkat

Malahias

et al. 2018

J Reconstr Microsurg Open

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Background The internal mammary lymph node (IMLN) basin is considered the second most important regional nodal basin in breast cancer. IMLNs are often not detected radiologically and left untreated, with symptomatic recurrence being 0.1%. Challenges in accessibility have been an obstacle in achieving a comprehensive treatment plan, especially with undetermined and radiologically enlarged IMLN. Free autologous tissue breast reconstruction is considered the gold standard, and the familiarity of microvascular surgeons in using the internal mammary vessels (IMVs) puts them in a unique position to shed more light on the natural pathological process of IMLN metastases. Materials and Methods A retrospective data analysis study was conducted evaluating 270 patients who underwent 307 free flaps for breast reconstruction using the IMV in the period between 2009 and 2017. Patient's demographics and clinicopathological data including IMLN harvest, radiological, operative details, adjuvant therapy, postoperative morbidity, and follow-up outcome data were analyzed. Results Eighty-nine enlarged IMLNs were surgically retrieved from 30.7% (83/270) of the patients (73 delayed, 10 immediate breast reconstructions) with an age range of 29 to 77 years (mean: 45). Eighty six were incidentally encountered during surgery, whereas in three, the enlarged IMLN was preoperatively, radiologically determined and biopsied during computed tomography (CT) scan staging and was retrieved

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“…The exception to this approach is isolated sternal or chest wall metastasis, which probably reflects isolated internal mammary lymph node recurrence. Chest wall resection of these metastases has demonstrated long-term survival 45,46. Most physicians reserve surgical resection for symptomatic, refractory, isolated bone metastases unresponsive to other treatment modalities.…”

Section: Methodsmentioning

confidence: 99%

Metastasectomy and Surgical Resection of the Primary Tumor in Patients With Stage IV Breast Cancer

et al. 2010

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Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.

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Chest wall resection for internal mammary lymph node metastases of breast cancer

Cited by 12 publications

References 48 publications

Incidence and Potential Significance of Internal Mammary Lymphadenopathy on Computed Tomography in Patients with a Diagnosis of Primary Breast Cancer

Incidence and Potential Significance of Internal Mammary Lymphadenopathy on Computed Tomography in Patients with a Diagnosis of Primary Breast Cancer

Impact of Surgically and Radiologically Detected Incidental Internal Mammary Lymph Node Enlargement in Breast Cancer Patients Undergoing Free-Flap Breast Reconstruction

Metastasectomy and Surgical Resection of the Primary Tumor in Patients With Stage IV Breast Cancer

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