Risk of Internal Mammary Lymph Node Metastases and Its Relevance on Prognosis of Breast Cancer Patients

Abstract

The risk of internal mammary chain metastases according to some parameters and its prognostic relevance was evaluated on the basis of the experience collected at the National Cancer Institute of Milan where, from January 1965 to December 1980, 1085 patients were submitted to Halsted mastectomy plus internal mammary chain dissection. A multivariate analysis was carried out, resorting to a multiple linear regression with logistic transformation of the dependent variable. The selection of prognostic factors has been performed with a step-down approach. The frequency of metastases to internal mammary chain nodes was evaluated according to four criteria: age, site and size of primary tumor, and presence of axillary metastases. Data of this series indicate that the frequency of internal mammary node metastases is significantly associated with the age of the patients (younger patients have a higher risk) (p = 0.006) with the size of primary tumor (p = 0.006) with the presence of axillary node metastases (p = 10(-9). Patients with both axillary and internal mammary positive nodes have a very poor prognosis (10-year survival 37.3%) while patients with either axillary metastases only or internal mammary metastases only have an intermediate less grave prognosis (59.6% and 62.4%, respectively). As regards the risk of internal mammary nodes involvement, it appears that knowing the age, the size, and the axillary nodes status, it is possible to calculate with good approximation the probability of their invasion.

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

“…The overall survival rates of patients with isolated internal mammary chain metastases are similar to those with isolated axillary lymph node involvement. The lowest survival rates are observed in patients with both axillary and internal mammary node metastases (Handley, 1975;Urban, 1978;Veronesi et al, 1983). Whether these ramifications of improved staging result in a survival benefit is unknown.…”

Sentinel Lymph Node Detection in Breast Cancer – First Experience/ Детекција На Сентинелни Лимфни Јазли Кај Карцином На Дојка – Први Искуства

“…Patients diagnosed with positive intramammary lymph nodes and negative axillary lymph nodes, have similar 10 years survival rate, approximately 60%, as patients with positive axillary lymph nodes [6,11].…”

“…The interest for this lymphatic pathway dates many years before the introduction of lymphoscintigraphy and SLN detection methods, when during the radical Halsted mastectomy the intramammary lymph nodes had been extirpated and histopathologically analyzed [7,8]. This radical type of mastectomy enabled the first insight in the intramammary lymphatic pathways and those first results also indicated that if positive for metastases, this lymph nodes correlate with worse disease outcome, more aggressive carcinoma variants and lower survival rate [9][10][11].…”

Can Helical Tomotherapy be used as a Safe Treatment Alternative for Breast Cancer Patients?

“…The multidisciplinary clinics decided to deliver chemotherapy followed by radiotherapy to the whole breast with a boost to the tumor bed, followed by an hormonotherapy using aromatase inhibitors. Also, due to the internal position and the size of the treated lesion [12,13], the internal mammary (IMN) and supra-clavicular nodes (SCN) required irradiation. The target volumes and OAR were then delineated on the planning CT scan in a treatment position as previously reported [14,15].…”