Internal mammary lymph drainage and sentinel node biopsy in breast cancer – a study on 1008 patients

Heuts, E. M.; Ent, F.W.C. van der; Meyenfeldt, M.F. von; Voogd, A.C.

doi:10.1016/s1359-6349(08)70490-7

Cited by 15 publications

(20 citation statements)

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“…1 Surgical studies have shown that the incidence of metastatic involvement of the internal mammary nodes varies between 4% and 9% in patients with axillary node-negative breast cancer and between 16% and 65% in patients with axillary node-positive breast cancer. [2][3][4] As a consequence, surgical dissection of the internal mammary nodes was attempted but abandoned in the 1970s, since no improvement in survival was observed.…”

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confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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“…As a consequence, internal mammary (IM) lymph node dissection was part of the standard surgical treatment in some centers in the 1950s and 1960s. This radical surgical procedure was abandoned in the 1970s because patient outcome studies showed that radical dissection did not improve survival [1].…”

Section: Figurementioning

confidence: 99%

“…A larger axillary metastatic load may represent a higher risk of IMC metastasis [1], and the total number of involved nodes in the two regions together may likewise be important from a prognostic aspect, but this is currently very difficult to assess, as IMC-LND is not part of the standard treatment of breast carcinoma [22]. In our study, no significant differences were found between patients with and without IM-SLN involvement in terms of age, tumor location, tumor size, axillary involvement, tumor grade or ER status.…”

Section: Internal Mammary Sentinel Lymph Node Biopsy In Breast Cancermentioning

confidence: 99%

Current issues in breast surgery

Maráz¹

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“…However, in some subgroups of patients it may be 28-52%. Heuts et al 24 evaluated the probability of pathologic positivity of IMN in the case of lymphoscintigraphic drainage into these nodes. Internal mammary nodes were detected in 20% of cases (196/1008).…”

Section: Incidence Of Imn Drainage and Imn Metastasismentioning

confidence: 99%

Internal mammary node management in breast cancer. A review

Vrána¹,

Gatěk²,

Cwiertka³

et al. 2013

BIOMED PAP

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Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed.

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Internal mammary lymph drainage and sentinel node biopsy in breast cancer – a study on 1008 patients

Cited by 15 publications

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Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Current issues in breast surgery

Internal mammary node management in breast cancer. A review

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