Intramammary Sentinel Lymph Nodes: What is the Clinical Significance?

Cox, Charles E.; Cox, John M.; Ramos, Daniel; Meade, Tammi

doi:10.1245/s10434-007-9769-x

“…The controversy lies in whether an IMLN testing positive for metastasis warrants a complete dissection of axillary lymph nodes, similar to a positive axillary lymph node, or whether the axillary lymph nodes can be spared. 59,[61][62][63][64][65] Irrespective of the controversy regarding the management of axillary lymph nodes in patients with an IMLN metastasis, the preoperative identification of IMLNs by US imaging and the investigation of these lymph nodes by US-guided FNA biopsy may be meaningful for the subsequent care of patients with breast cancer.…”

Section: Fna Of Lymph Nodes In Breast Cancer/krishnamurthymentioning

confidence: 99%

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Krishnamurthy

¹

2009

Cancer Cytopathology

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Staging of disease is routine in the evaluation of patients newly diagnosed with breast cancer. Assessment of palpable and/or nonpalpable locoregional lymph nodes is an important component of the initial staging.Ultrasound (US) is the favored imaging modality for the initial investigation of lymph nodes and results in a significant increase in the specificity of the overall evaluation when used in conjunction with fine-needle aspiration (FNA). This review provides a concise summary, based on published literature, of the current applications and future prospects of FNA biopsy of locoregional lymph nodes in the initial staging and subsequent surgical management of patients with breast cancer. Patients undergo either sentinel lymph node (SLN) biopsy or complete axillary lymph node dissection, based on whether the axillary lymph node status is determined to be negative or positive in the initial staging process. The status of lymph nodes in the supraclavicular, infraclavicular, and internal mammary regions provides more accurate staging information and also impacts subsequent surgical management. The identification and evaluation of intramammary lymph nodes can add value in the overall assessment of patients with breast cancer. The feasibility of noninvasive imaging modalities for SLN mapping in animal models has indicated a good potential for FNA biopsy in the subsequent investigation of SLNs identified noninvasively in humans. Staging of the malignant tumor is a routine component in the assessment of patients who are newly diagnosed with breast cancer. Breast cancer staging aids in the appropriate management of patients at each stage of disease and is useful in estimating the prognosis for a patient at a particular stage. The routine staging process includes taking a thorough history of the patient, physical examination, mammography, ultrasonography (US) of the breast and lymph node basins, computed tomography (CT) scan of the abdomen, bone scanning, and chest radiography. Cancer is assigned a clinical stage at the time of the initial diagnosis based on the findings of the physical examination, radiologic studies, and core needle biopsy (CNB) of the

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“…Por outro lado, a prevalência desse achado na anatomia patológica é de 1 a 28% 7, 15 . As poucas séries de casos relatando o linfonodo IM são provenientes de bancos de dados de serviços com casuística superior a 3.600 pacientes, alcançadas num período superior a cinco anos [8][9][10][11]14,16 . A identificação do linfonodo IM pode ocorrer no pré-operatório ou na peça cirúrgica e, quando identificado, deve ser sempre biopsiado 17 ou removido 8, 17,18 .…”

Section: Discussionunclassified

“…Diaz et al 26 , em estudo de revisão da literatura relacionada a LS-IM comprometido, e LS axilar sem metástase, submetidas ao esvaziamento axilar, observaram apenas 14 mulheres, não se encontrando doença metastática no produto do esvaziamento, sugerindo a conduta expectante nesses casos, conduta também proposta por outros autores 10,11,14,17,21 . Porém, no segundo caso, observou-se a presença de metástase axilar no produto da linfadenectomia, fato que vem em desacordo com essa revisão, tornando, nessas circunstâncias, a positividade na ordem de 6,2% (1/16).…”

Section: Referênciasunclassified

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

Vieira¹,

Viviani²,

Ferreira³

et al. 2012

Rev. Bras. Ginecol. Obstet.

0

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ResumoA pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS) extra-axilar e intramamário (IM) ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação. AbstractThe sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

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“…Por outro lado, a prevalência desse achado na anatomia patológica é de 1 a 28% 7,15 . As poucas séries de casos relatando o linfonodo IM são provenientes de bancos de dados de serviços com casuística superior a 3.600 pacientes, alcançadas num período superior a cinco anos [8][9][10][11]14,16 . A identificação do linfonodo IM pode ocorrer no pré-operatório ou na peça cirúrgica e, quando identificado, deve ser sempre biopsiado 17 , os tumores T2 a T4 16 e a multifocalidade 9 .…”

Section: Discussionunclassified

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

Vieira¹,

Viviani²,

Ferreira³

et al. 2012

Rev. Bras. Ginecol. Obstet.

1

0

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ResumoA pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS) extra-axilar e intramamário (IM) ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação. AbstractThe sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

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Intramammary Sentinel Lymph Nodes: What is the Clinical Significance?

Cited by 24 publications

References 4 publications

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

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