Reappraisal of internal mammary node metastases as a prognostic factor in patients with breast cancer

Abstract

Clinical, histologic, and biologic prognostic factors were examined in 144 patients with invasive breast cancer. It was determined whether variable prognostic factors, especially internal mammary lymph node metastases, would serve as a basis for the prognosis of breast cancer. In a univariate study, overall survival was significantly correlated with tumor size, axillary lymph node status, axillary and internal mammary lymph node metastases, and DNA ploidy status. Especially among patients with one to three positive axillary nodes, survival in case of internal mammary involvement were significantly lower than without internal mammary involvement. In a multivariate study, only axillary and internal mammary lymph node metastases were recognized as important, independent prognostic factors of survival, but neither axillary lymph node status nor DNA ploidy status appeared as important prognostic factors. It was concluded that internal mammary lymph node metastases is additional prognostic factor, especially in patients with one to three positive axillary nodes. Because axillary and internal mammary lymph node metastases could not be predicted from their clinical assessment, axillary lymph node dissection and biopsy of internal mammary nodes may be a useful staging procedure for these patients.

Patient Preference for Dissection of Sentinel Nodes Outside Level I-II of the Axilla

“…The status of axillary and internal mammary lymph nodes (IMN) is one of the most signi cant prognostic factors for survival in breast cancer (1)(2)(3)(4). The reappraisal of internal mammary node metastases as a prognostic factor and the results of recent publications of trials of postmastectomy irradiation have aroused discussion about adopting routine elective IMN irradiation despite potential serious cardiac morbidity (4)(5)(6).…”

Predictors of Axillary Lymph Node Status in Early Breast Cancer: A Single Center Analysis of 81 patients at a Tertiary Care Hospital in North-East India

“…Also, the tumors located medially have high rates of failure because they are related to the lymphatic drainage to the internal mammary lymph nodes and the SLNB of these nodes are not performed. The internal mammary lymph nodes have the same prognostic significance as axillary nodal metastasis [18,19] . O'Hea et al reported that the accuracy of SLNB decreases with the increasing tumor size [20] .…”

Surgery for Breast Cancer

“…[298][299][300] Isolated internal mammary nodal metastases carry the same prognostic implications as isolated axillary nodal metastases. 301,302 If the identification of such metastases would alter therapeutic management, then the determination by lymphoscintigraphy of those few patients with internal mammary drainage patterns, and sentinel lymphadenectomy of those nodes, would be justified. The presence of both internal mammary and axillary drainage has significant adverse prognostic significance, but because most patients with internal mammary drainage also have axillary drainage, an effort to map internal mammary sentinel nodes has the potential to benefit only a small number of patients.…”