Long-Term Outcome of Internal Mammary Lymph Node Detected by Lymphoscintigraphy in Early Breast Cancer

Abstract

PurposeInternal mammary lymph node (IMLN) metastasis is an important prognostic indicator in breast cancer. However, the necessity of internal mammary sentinel lymph node biopsy for accurate staging, for choosing adjuvant treatment, and as a prognostic indicator, has remained controversial.MethodsFrom January 2001 to December 2006, 525 female breast cancer patients underwent radical surgery after preoperative lymphatic scintigraphy. We retrospectively analyzed the follow-up results, recurrences, and deaths of all patients.ResultsThere was no significant difference in the clinicopathological characteristics between the axilla and the IMLN groups. The median follow-up period was 118.8 months (range, 7-122 months) in the axilla group and 107.7 months (range, 14-108 months) in the IMLN group. During the median follow-up period, the breast cancer-related death rate in the axilla group was 3.6%, which was not significantly different from that of the IMLN group (1.3%) (p=0.484). The five-year survival rates did not differ between the two groups (p=0.306). The overall recurrence rate and the locoregional recurrence rate also did not differ between the two groups (p=0.835 and p=0.582, respectively). The recurrence rate of IMLN (both ipsilateral and contralateral) metastasis was very low, accounting for 0.5% in the axilla group and 1.3% in the IMLN group (p=0.416).ConclusionThe long-term follow-up results showed that there was no significant difference in both overall outcome and regional recurrence between the two groups. Therefore, the requirement for identification of nodal basins outside the axilla or IMLN sentinel biopsy should be reconsidered.

Incidental Internal Mammary Lymph Nodes Visualized on Screening Breast MRI

“…In addition, the survival benefit afforded by surgical excision of internal mammary lymph nodes has not been conclusively shown [6,26]. Because the benefit is unclear and potential complications surround internal mammary node excision, most internal mammary lymph node metastasis patients are treated with adjuvant chemotherapy or radiation rather than surgical dissection [27].…”

Internal mammary node management in breast cancer. A review

“…However, no statistically significant difference was found for overall survival (OS; 78% versus 64%; P=0.08). No overall survival differences were reported either by Koo et al 49 , Fisher et al 50 , and Arriagada et al 51 . Overall survival and disease free survival are summarized in Tables 2 and 3.…”

Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time?

“…Koo et al on the other hand states that internal mammary SLNB (IMSLNB) can be omitted in early breast cancer. In a study concerning 525 patients', he demonstrated no significant difference in survival outcomes of those who did and those who did not have IMSLNB [20]. According to Birdwell et al, scintigrams are not mandatory especially if internal mammary node status is not acted upon [18].…”