Clinical Implications of Micrometastasis Detection in Internal Mammary Nodes of Breast Cancer Patients

Abstract

Breast CareFor a long time, mastectomy was routinely used to establish local control. However women now have the option of breastconserving treatment followed by radiotherapy [4,5]. The lymph nodes outside the axilla, including the internal mammary lymph nodes (IMLNs), are not usually resected in the operation [6,7]. Recently sentinel lymph node biopsy has been identified as a new diagnostic procedure to determine KeywordsBreast cancer · Internal mammary nodes · Micrometastasis ·Step-serial sectioning SummaryBackground: The aim of this study was to assess the efficiency of step-serial sectioning (SSS) combined with hematoxylin and eosin (H&E) and immunohistochemical (IHC) staining in detecting micrometastasis of internal mammary lymph nodes (IMLNs). Patients and Methods: 135 IMLNs from 88 breast cancer patients were re-examined by SSS, combined with either H&E or IHC staining of the biomarkers cytokeratin-19 and epithelial membrane antigen. Results: Of the 135 IMLNs, 6 nodes from 5 cases displayed 1 or more micrometastases. Histological grade and lymphovascular invasion status were significantly correlated with micrometastasis in the IMLNs (p = 0.018 and 0.001, respectively). Of the 6 nodes positive for micrometastasis, 1 node was detected by both H&E and IHC staining. The remaining 5 nodes from 4 cases showed evident tumor cells only by IHC staining. Finally 8 of the 83 patients (9.64%) without IMLN metastasis showed distant metastasis, while 2 of the 5 patients (40%) with IMLN metastasis showed distant metastasis within 28 months of operation. Conclusion: SSS combined with H&E and IHC staining is more efficient in detecting micrometastasis than classic routine single-slice H&E only.

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

“…Thus identifying predictive factors for IMLN metastasis can spare low-risk patients from the complications of IMLN biopsy or irradiation. Several studies have attempted to identify these factors, however the results have been conflicting [24,26,28,30,[49][50][51]. Most of the studies suggest that positive axillary node status is the strongest association with IMLN metastases [49,50].…”

“…Several studies have attempted to identify these factors, however the results have been conflicting [24,26,28,30,[49][50][51]. Most of the studies suggest that positive axillary node status is the strongest association with IMLN metastases [49,50]. However, the study by Leidenius et al reported that patients without positive axillary metastases tend to have increased IMLN drainage, resulting in higher rate of IMLN metastases [26].…”

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

“…Whether the internal mammary lymph nodes should be dissected for patients with breast cancer remains a controversial issue [34,35,36]. We reported the first meta-analysis of the rate of positive IML nodes in breast cancer patients.…”

<p>Proteomics of Sentinel Lymph Nodes in Early Breast Cancer for Identification of Thymidylate Synthase as a Potential Biomarker to Flag Metastasis: A Preliminary Study</p>

“…These were further sectioned into 4 µm poly-L-lysine-coated slides. 35 These paraffin sections were de-paraffinized with three subsequent washes in xylene and then rehydrated by washing them stepwise in 100% ethanol, 90% ethanol, 70% ethanol and distilled water. The sections were stained with hematoxylin and washed in running water for 5 minutes.…”