Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases

Heuts, E. M.; Ent, F.W.C. van der; Hulsewé, Karel W. E.; Meyenfeldt, M.F. von; Voogd, Adri C.

doi:10.1016/j.breast.2009.05.003

Cited by 36 publications

(32 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We selected 6 studies that fulfilled the following criteria: a large number of patients, peritumoral or intratumoral tracer injection, internal mammary biopsy successfully achieved in most patients with internal mammary drainage, and axilla staged routinely independent of internal mammary status (47)(48)(49)(50)(51)(52).…”

Section: Probability Of Internal Mammary Involvement In Patients Withmentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

View full text Add to dashboard Cite

Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the factors influencing the false-negative rate of SNB in breast cancer; (2) the risks associated with the use of the technique in specific situations such as large tumors, multiple ipsilateral tumors, or the setting of neoadjuvant chemotherapy; and (3) the meaning of internal mammary drainage on lymphoscintigraphy in terms of risk of occult internal mammary involvement.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through March 2012.Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (,5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.Key Words: sentinel node biopsy; breast cancer; micrometastases; lymphoscintigraphy; internal mammary node; radiation therapy; neoadjuvant chemotherapy Because imaging techniques have limited sensitivity, the axilla must be explored surgically. Traditional staging requires levels I and II axillary lymph node dissection (ALND) with 10 or more removed nodes (3). Axillary involvement is found in 10%-30% of patients with T1 (#2 cm) tumors, depending on size. This rate reaches 45% for small T2 tumors (2.1-3 cm) and 55%-70% for larger tumors (2,4). However, routine ALND carries the risk of lymphedema, sensory disturbances, and chr...

show abstract

Section: Probability Of Internal Mammary Involvement In Patients Withmentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…Eventually, 15 articles met the inclusion criteria [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27], containing a total of 4,248 breast cancer patients who underwent IML node dissection. The number of patients ranged from 30 to 1,213 for each study and the average age was from 47 to 61 years.…”

Section: Resultsmentioning

confidence: 99%

“…Surgical treatment alone cannot improve the patients' survival rate [45,46]. In 2009, Heuts et al [26] reported that internal mammary sentinel node (IMSN) biopsy changed the adjuvant systemic treatment in 7 IML node-positive patients. 5 of them were axillary node negative.…”

Section: Discussionmentioning

confidence: 99%

“…The regional lymph node status is not only critical for clinical staging and adjuvant therapy selection, but it is also the most significant independent factor for breast cancer prognosis [32]. The IML node chain is the most important area of the breast lymphatic drainage outside of the axillary cavity, and also the first stop of lymph drainage to the internal mammary lymph nodes in patients with breast cancer [26]. In 2012, the American Joint Committee on Cancer TNM Staging System for Breast Cancer specified: ‘N2b: metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

Gu²,

Tong

et al. 2013

Onkologie

View full text Add to dashboard Cite

Background: Knowing the status of the internal mammary lymph (IML) nodes is important for accurate staging and appropriate selection of subsequent treatment in breast cancer. We conducted a meta-analysis to clarify the rate of IML node metastasis in breast cancer patients and discussed the importance of this finding. Methods: We retrieved articles from the literature that reported positive rates of IML node metastasis in breast cancer patients. The quality of the selected articles was assessed using the ‘Methodological Index for Non-Randomized Studies'. The heterogeneity was tested, and publication bias was assessed using a funnel plot. Finally, the positive rate of IML node metastasis in breast cancer patients was calculated using the random-effects model. Results: 15 articles met the inclusion criteria and a total of 4,248 patients were included in the analysis. Heterogeneity across the studies was statistically significant (p = 0.014); thus, the random-effects model was used and the calculated positive rate of IML node metastasis was 23% (95% confidence interval (CI), 0.21-0.25). Conclusions: Approximately 23% of the breast cancer patients had IML node metastases, for which the prognosis is generally poor. Accurate staging and integrated treatment are necessary to improve the survival of these patients.

show abstract

“…The advances in the sentinel lymph node biopsy (SLN) procedure have led to a re-evaluation of the role of the SLN for staging IMLN basin [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. In addition, few recent clinical trials demonstrate that post-mastectomy irradiation of IMLNs significantly improved the metastasis-free overall survival of patients with stage I-III breast cancer [34][35][36].…”

Section: Introductionmentioning

confidence: 99%

The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients

Zhang

Jaffer

Bleiweiss

et al. 2015

Breast Cancer Res Treat

View full text Add to dashboard Cite

The clinical significance of IMLN metastases in breast cancer is controversial. Although IMLN status is an integral part of current AJCC staging of breast cancer, the elective sampling of IMLN is not part of routine surgery for breast cancer. The purpose of this study was to determine the incidence of IMLN metastases, associated risk factors if any, and its impact on further management and outcome. We retrospectively studied 470 cases that underwent autologous reconstruction surgery between 2002 and 2014. Of 470 cases, 157 breast cancer cases had histology-confirmed IMLN removal during the reconstruction. Only 9 patients (6 %) showed IMLN metastases as compared to 45 (34 %) that showed axillary nodal metastases (p < 0.01). Interestingly, 4 patients had metastases limited to IMLN without any metastases to axillary nodes. IMLN metastasis was significantly associated with age <40 years, lymphovascular invasion, and negative PR status. IMLN metastasis resulted in upstaging of 2 patients from stage I to III, and 1 from stage II to III. Five patients received additional chest wall radiation to target the positive IMLNs. Nine of 157 (6 %) patients with IMLN removal during reconstruction had loco-regional recurrence/metastasis as compared to 20 of 293 (7 %) patients without IMLN removal (p > 0.05) (follow-up, 1-134 months). The overall rate of IMLN metastases (6 %) is much lower than the rate of axillary node metastases. Selective biopsy of IMLNs in patients with breast cancer, especially if younger than 40 years, and with lymphovascular invasion and negative PR status, may guide adjuvant treatment.

show abstract

Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases

Cited by 36 publications

References 17 publications

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

A Meta-Analysis of Internal Mammary Lymph Node Metastasis in Breast Cancer Patients

The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients

Contact Info

Product

Resources

About