Incidence of intramammary nodes in completion mastectomy specimens after axillary node sampling: Implications for breast conserving surgery

Rampaul, R.S.; Dale, Øystein; Mitchell, Marci R.; Blamey, R.W.; Macmillan, R.D.; Robertson, J. F. R.; Ellis, Ian O.

doi:10.1016/j.breast.2007.09.004

Cited by 19 publications

(17 citation statements)

References 16 publications

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“…Assuming the situation where a patient has two ALNs involved and one IMLN involved, these patients will no longer be eligible. Furthermore, Rampaul et al () demonstrated the upstaging of a patient's final histology on the basis of IMLNs as discussed before.…”

Section: Discussionmentioning

confidence: 95%

Time to redefine the intramammary lymph node as a separate entity?

et al. 2018

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The lymphatic drainage for the majority of primary breast tumors is to the axillary lymph nodes (ALNs). Some, however, drain to the so-called extra-axillary basins, namely the internal mammary, supra- and infraclavicular regions. Another potential drainage route includes the intramammary lymph nodes (IMLNs). Current guidance suggests IMLNs should be considered as part of the axillary group, potentially affecting axillary management. However, due to evolution in imaging and advancement in technology, IMLNs may now be distinguished more accurately pre-operatively. There are currently no published guidelines for the management of IMLNs in the United Kingdom. The authors suggest that it is time to reclassify IMLNs as a separate focus of cancer and treat it as a separate entity. Clin. Anat. 31:684-687, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 95%

Time to redefine the intramammary lymph node as a separate entity?

et al. 2018

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“…Since the majority of the intra‐MLNs are located in the upper outer quadrant, they are most likely in the path of the lymphatic drainage to the axilla. Moreover, it has been reported that a fraction of the intra‐MLNs could be marked as SLN …”

Section: Discussionmentioning

confidence: 99%

“…The majority of them are identified incidentally by imaging or by pathologic examination . Although the incidence has been reported to be up to 48%, other studies have shown this to occur only rarely . In one meta‐analysis that included 18 studies, the overall incidence was about 1% .…”

Section: Introductionmentioning

confidence: 99%

The clinical significance of metastatic breast carcinoma to intramammary lymph node

Khoury

Fang²,

Karabakhtsian

et al. 2019

Breast J

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The incidence of involved intramammary lymph node (intra‐MLN) with breast carcinoma (BC) is rare. Its clinical significance and impact on the clinical decision making is unclear. A total of 113 BC cases with at least one positive intra‐MLN were collected from 11 academic institutions. The inclusion criteria were subsequent axillary lymph node dissection, and the availability of information on T‐stage, size of node metastasis, extranodal extension status, biomarkers status, and clinical follow‐up. Stage 4 cases and/or neo‐adjuvant treated patients were excluded. AJCC TN‐stage was calculated twice, with and without intra‐MLN. Five‐year overall survival (OS) and relapse (local and/or distant)‐free survival (RFS) were calculated and correlated with the clinicopathologic variables. Excluding intra‐MLN, TN‐stage correlated with OS (P = .016) but not with RFS (P = .19). However, when intra‐MLN was included, TN‐stage correlated with both OS (P < .001) and RFS (P = .016). In the multivariate analysis, when intra‐MLN was excluded, only radiation therapy (RT) correlated with RFS (HR = 0.19, 95% CI: 0.054‐0.66, P = .009). However, when intra‐MLN was included in the TN‐stage both RT (HR = 0.13, 95% CI: 0.04‐0.45, P = .001) and TN‐stage 3 (HR = 8.92, 95% CI: 1.47‐54, P = .017) correlated with RFS. Tumor multifocality was the only variable correlated with OS when the intra‐MLN involvement was excluded. When intra‐MLN was included, multifocality became insignificant but TN‐stage 3 correlated with OS (HR = 8.59, 95% CI: 1.06‐69.71, P = .044). Positive intra‐MLN is an independent factor in predicting both RFS and OS.

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“…Several authors have reported diverse identification rates of iMLNs ranging from 0.2 to 48% [3,5,10,11,12,13,14]. This variability was caused by the use of different detection methods, including autopsy, pathologic review and retrospective chart review.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Meaning of Intramammary Lymph Nodes

Lee¹,

Kim²,

Choi³

et al. 2012

Oncology

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Objective: The clinical meaning of intramammary lymph nodes (iMLNs) is uncertain. We wanted to describe the clinical characteristics and understand the implications of iMLNs detected by sentinel LN biopsy (SLNB). Methods: We reviewed the clinical, radiological and pathological records of women diagnosed with invasive carcinoma of the breast at the Samsung Medical Center between January 2001 and January 2011. A total of 69 patients were identified, and SLNB was performed in 31 patients. Results: Of the 69 patients included in the study, 22 (31.9%) had metastases in iMLNs. The presence of lymphovascular invasion and the number of axillary LN metastases were associated with iMLN metastasis. Of the 31 patients who underwent SLNB, there were no cases with axillary LN metastasis when axillary SLNB was negative, even in cases of iMLN-positive patients. Of the 10 patients in whom intramammary SLNs (iMSLNs) were detected during SLNB, 8 patients without iMLN metastases were also negative for axillary LNs. Conclusion: Patients with metastatic iMLNs had more aggressive cancers with lymphovascular invasion and increased axillary LN metastases. When iMSLN was detected by SLNB, performing of axillary dissection could be determined by the status of the iMSLN itself.

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Incidence of intramammary nodes in completion mastectomy specimens after axillary node sampling: Implications for breast conserving surgery

Cited by 19 publications

References 16 publications

Time to redefine the intramammary lymph node as a separate entity?

Time to redefine the intramammary lymph node as a separate entity?

The clinical significance of metastatic breast carcinoma to intramammary lymph node

The Clinical Meaning of Intramammary Lymph Nodes

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