Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582

    Article  CAS  PubMed  Google Scholar 

  2. Bass SS, Lyman GH, McCann CR et al (1999) Lymphatic mapping and sentinel lymph node biopsy. Breast J 5:288–295

    Article  PubMed  Google Scholar 

  3. Lamonica D, Edge SB, Hurd T, Proulx G, Stomper PC (2003) Mammographic and clinical predictors of drainage patterns in breast lymphoscintigrams obtained during sentinel node procedures. Clin Nucl Med 28:558–564

    Article  PubMed  Google Scholar 

  4. Estourgie SH, Nieweg OE, Olmos RA et al (2004) Lymphatic drainage patterns from the breast. Ann Surg 239:232–237

    Article  PubMed Central  PubMed  Google Scholar 

  5. Lacour J, Bucalossi P, Cacers E et al (1976) Radical mastectomy versus radical mastectomy plus internal mammary dissection: five-year results of an international cooperative study. Cancer 37:206–214

    Article  CAS  PubMed  Google Scholar 

  6. Lacour J, Le M, Caceres E, Koszarowski T, Veronesi U, Hill C (1983) Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten-year results of an international cooperative trial in breast cancer. Cancer 51:1941–1943

    Article  CAS  PubMed  Google Scholar 

  7. Veronesi U, Cascinelli N, Greco M et al (1985) Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 202:702–707

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Donegan WL (1977) The influence of untreated internal mammary metastases upon the course of mammary cancer. Cancer 39:533–538

    Article  CAS  PubMed  Google Scholar 

  9. Livingston SF, Arlen M (1974) The extended extrapleural radical mastectomy: its role in the treatment of carcinoma of the breast. Ann Surg 179:260–265

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Dahl-Iversen E, Tobiassen T (1969) Radical mastectomy with parasternal and supraclavicular dissection for mammary carcinoma. Ann Surg 170:889–891

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Urban JA (1978) Management of operable breast cancer: the surgeon’s view. Cancer 42:2066–2077

    Article  CAS  PubMed  Google Scholar 

  12. Cody HS 3rd, Urban JA (1995) Internal mammary node status: a major prognosticator in axillary node-negative breast cancer. Ann Surg Oncol 2:32–37

    Article  PubMed  Google Scholar 

  13. Sohn VY, Arthurs ZM, Sebesta JA, Brown TA (2008) Primary tumor location impacts breast cancer survival. Am J Surg 195:641–644

    Article  PubMed  Google Scholar 

  14. Colleoni M, Zahrieh D, Gelber RD et al (2005) Site of primary tumor has a prognostic role in operable breast cancer: the international breast cancer study group experience. J Clin Oncol 23:1390–1400

    Article  PubMed  Google Scholar 

  15. AJCC Cancer Staging Handbook (2009) New York: Springer

  16. Jansen L, Doting MH, Rutgers EJ et al (2000) Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer. Br J Surg 87:920–925

    Article  CAS  PubMed  Google Scholar 

  17. Johnson N, Soot L, Nelson J et al (2000) Sentinel node biopsy and internal mammary lymphatic mapping in breast cancer. Am J Surg 179:386–388

    Article  CAS  PubMed  Google Scholar 

  18. van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG (2001) Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 234:79–84

    Article  PubMed Central  PubMed  Google Scholar 

  19. Sugg SL, Ferguson DJ, Posner MC, Heimann R (2000) Should internal mammary nodes be sampled in the sentinel lymph node era? Ann Surg Oncol 7:188–192

    Article  CAS  PubMed  Google Scholar 

  20. Dupont E, Cox CE, Nguyen K et al (2001) Utility of internal mammary lymph node removal when noted by intraoperative gamma probe detection. Ann Surg Oncol 8:833–836

    Article  CAS  PubMed  Google Scholar 

  21. Paganelli G, Galimberti V, Trifirò G et al (2002) Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 46:138–144

    CAS  PubMed  Google Scholar 

  22. Tanis PJ, Nieweg OE, Valdés Olmos RA et al (2002) Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer 87:705–710

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Estourgie SH, Tanis PJ, Nieweg OE et al (2003) Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients. Ann Surg Oncol 10:935–941

    Article  PubMed  Google Scholar 

  24. Paredes P, Vidal-Sicart S, Zanon G et al (2005) Clinical relevance of sentinel lymph nodes in the internal mammary chain in breast cancer patients. Eur J Nucl Med Mol Imaging 32:1283–1287

    Article  PubMed  Google Scholar 

  25. Hong J, Choy E, Soni N et al (2005) Extra-axillary sentinel node biopsy in the management of early breast cancer. Eur J Surg Oncol 31:942–948

    Article  CAS  PubMed  Google Scholar 

  26. Leidenius MH, Krogerus LA, Toivonen TS, Leppanen EA, von Smitten KA (2006) The clinical value of parasternal sentinel node biopsy in breast cancer. Ann Surg Oncol 13:321–326

    Article  PubMed  Google Scholar 

  27. Madsen E, Gobardhan P, Bongers V et al (2007) The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 14:1486–1492

    Article  PubMed Central  PubMed  Google Scholar 

  28. Coombs NJ, Boyages J, French JR, Ung OA (2009) Internal mammary sentinel nodes: ignore, irradiate or operate? Eur J Cancer 45:789–794

    Article  PubMed  Google Scholar 

  29. Long H, Lin Z, Situ D, Ma G, Zheng Y, Rong T (2011) Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients. Breast 20:129–133

    Article  PubMed  Google Scholar 

  30. Postma EL, Van Wieringen S, Hobbelink MG, Verkooijen HM, Van den Bongard HJGD, Borel Rinkes IHM (2012) Sentinel lymph node biopsy of the internal mammary chain in breast cancer. Breast Cancer Res Treat 134:735–741

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Kim H, Shin MJ, Kim SJ, Kim IJ, Park I (2014) The relation of visualization of internal mammary lymph nodes on lymphoscintigraphy to axillary lymph node metastases in breast cancer. Lymphat Res Biol 12:295–300

    Article  PubMed  Google Scholar 

  32. Qiu PF, Liu JJ, Liu YB, Yang GR, Sun X, Wang YS (2012) A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in breast cancer patients. Breast Cancer Res Treat 136:319–321

    Article  PubMed  Google Scholar 

  33. Caudle AS, Yi M, Hoffman KE, Mittendorf EA, Babiera GV, Hwang RF, Meric-Bernstam F, Sahin AA, Hunt KK (2014) Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients. Ann Surg Oncol 21:60–65

    Article  PubMed  Google Scholar 

  34. Heuts EM, van der Ent FW, Hulsewe KW, von Meyenfeldt MF, Voogd AC (2009) Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases. Breast 18:254–258

    Article  CAS  PubMed  Google Scholar 

  35. Hennequin C, Bossard N, Servagi-Vernat S et al (2013) Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys 86:860–866

    Article  PubMed  Google Scholar 

  36. Thorsen LB, Thomsen MS, Berg M et al (2014) Danish Breast Cancer Cooperative Group Radiotherapy committee. CT-planned internal mammary node radiotherapy in the DBCG-IMN study: benefit versus potentially harmful effects. Acta Oncol 53:1027–1034

    Article  PubMed  Google Scholar 

  37. Schaverien MV, Purdie CA, Munnoch DA (2013) Clinical value of internal mammary lymph node metastases found incidentally during free flap recipient vessel exposure. Eur J Surg Oncol 39:608–612

    Article  CAS  PubMed  Google Scholar 

  38. Handley RS, Thackray AC (1954) Invasion of internal mammary lymph nodes in carcinoma of the breast. Br Med J 1:61–63

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Hutchinson WB, Kiriluk LB (1956) Internal mammary node investigation in carcinoma of the breast. Am J Surg 92:151–155

    Article  CAS  PubMed  Google Scholar 

  40. Caceres E (1959) Incidence of metastasis in the internal mammary chain in operable cancer of the breast. Surg Gynecol Obstet 108:715–720

    CAS  PubMed  Google Scholar 

  41. Bucalossi P, Veronesi U, Zingo L, Cantu C (1971) Enlarged mastectomy for breast cancer. Review of 1,213 cases. Am J Roentgenol Radium Ther Nucl Med 111:119–122

    Article  CAS  PubMed  Google Scholar 

  42. Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR (2008) Internal mammary nodes in breast cancer: diagnosis and implications for patient management: a systematic review. J Clin Oncol 26:4981–4989

    Article  PubMed  Google Scholar 

  43. Li Z, Gu X, Tong J, Liu B, Sun L, Gao X, Jiang X (2013) A meta-analysis of internal mammary lymph node metastasis in breast cancer patients. Onkologie 36:747–752

    Article  PubMed  Google Scholar 

  44. Andree C, Schmidt VJ, Munder BI et al (2012) Detecting of breast cancer metastasis by means of regional lymph node sampling during autologous breast reconstruction—a screening of 519 consecutive patients. Med Sci Monit 18:605–610

    Google Scholar 

  45. Fischer JP, Nelson JA, Au A, Tuggle CT 3rd, Serletti JM, Wu LC (2014) Complications and morbidity following breast reconstruction–a review of 16,063 cases from the 2005–2010 NSQIP datasets. J Plast Surg Hand Surg 48:104–114

    Article  PubMed  Google Scholar 

  46. Yi Ann, Kim Hak Hee, Shin Hee Jung, Huh Mi Ock, Ahn Seung Do, Seo Bo Kyeong (2009) Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean J Radiol 10:496–507

    Article  PubMed Central  PubMed  Google Scholar 

  47. Hennequin C, Romestaing P, Maylin C (2008) Irradiation of lymph nodes areas in breast cancer. Cancer Radiother 12:559–564

    Article  CAS  PubMed  Google Scholar 

  48. Jin Jian-Yue, Klein Eric E, Kong Feng-Ming, Li Zuofeng (2005) An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers. J Appl Clin Med Phys 6:84–93

    Article  PubMed  Google Scholar 

  49. Galimberti V, Veronesi P, Arnone P et al (2002) Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol 9:924–928

    Article  PubMed  Google Scholar 

  50. Zeng J, Xie H, Lu Y, Feng Z, Li F (2012) Clinical implications of micro metastasis detection in internal mammary nodes of breast cancer patients. Breast Care (Basel) 7:216–219

    Article  Google Scholar 

  51. Huang O, Wang L, Shen K et al (2008) Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2,269 Chinese breast cancer patients treated with extended radical mastectomy. Breast Cancer Res Treat 107:379–387

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Xiaofei Zhang, Shabnam Jaffer, Ira J. Bleiweiss & Anupma Nayak

Authors
  1. Xiaofei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shabnam Jaffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ira J. Bleiweiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anupma Nayak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anupma Nayak.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Jaffer, S., Bleiweiss, I.J. et al. The clinical significance of internal mammary lymph node (IMLN) biopsy during autologous reconstruction in breast cancer patients. Breast Cancer Res Treat 153, 565–572 (2015). https://doi.org/10.1007/s10549-015-3569-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3569-y

Keywords

Search

Navigation