BACKGROUND: Metastases to internal mammary lymph nodes (IMN) may occur in patients with breast cancer and may alter treatment recommendations. The purpose of this study was to identify the frequency of IMN drainage in patients undergoing breast lymphoscintigraphy and sentinel lymph node dissection (SLND). METHODS: The combined technique of peritumoral injection of radiocolloid and Lymphazurin blue for SLND was performed on 220 patients. All patients underwent preoperative lymphoscintigraphy before SLND. Lesion location by quadrant included: 110 upper outer (UOQ), 49 lower outer (LOQ), 30 upper inner (UIQ), 24 lower inner (LIQ), and 7 central. RESULTS: Drainage to any nodal basin was observed in 184 of 220 patients (84%). IMN drainage was documented in 37 of 220 (17%) of patients. IMN drainage without evidence of axillary drainage occurred in 2 of 220 patients(1%). Drainage to the IMN based on quadrant location of the lesion was as follows: UOQ, 10%; LOQ, 27%; UIQ, 17%; LIQ, 25%; and central, 29%. CONCLUSIONS: Internal mammary lymph node drainage shown by breast lymphoscintigraphy is common. Tumors in all quadrants may drain to IMNs, although drainage is significantly more common from quadrants other than the UOQ. Further studies are needed to determine whether lymphoscintigraphy drainage patterns identify patients at the highest risk for IMN metastases who may benefit from radiotherapy.
BACKGROUND:Metastases to internal mammary lymph nodes (IMN) may occur in patients with breast cancer and may alter treatment recommendations. The purpose of this study was to identify the frequency of IMN drainage in patients undergoing breast lymphoscintigraphy and sentinel lymph node dissection (SLND). METHODS: The combined technique of peritumoral injection of radiocolloid and Lymphazurin blue for SLND was performed on 220 patients. All patients underwent preoperative lymphoscintigraphy before SLND. Lesion location by quadrant included: 110 upper outer (UOQ), 49 lower outer (LOQ), 30 upper inner (UIQ), 24 lower inner (LIQ), and 7 central. RESULTS: Drainage to any nodal basin was observed in 184 of 220 patients (84%). IMN drainage was documented in 37 of 220 (17%) of patients. IMN drainage without evidence of axillary drainage occurred in 2 of 220 patients(1%). Drainage to the IMN based on quadrant location of the lesion was as follows: UOQ, 10%; LOQ, 27%; UIQ, 17%; LIQ, 25%; and central, 29%. CONCLUSIONS: Internal mammary lymph node drainage shown by breast lymphoscintigraphy is common. Tumors in all quadrants may drain to IMNs, although drainage is significantly more common from quadrants other than the UOQ. Further studies are needed to determine whether lymphoscintigraphy drainage patterns identify patients at the highest risk for IMN metastases who may benefit from radiotherapy.
Authors: Iris M C van der Ploeg; Omgo E Nieweg; Bin B R Kroon; Emiel J T Rutgers; Marie-Jeanne T F D Baas-Vrancken Peeters; Wouter V Vogel; Cornelis A Hoefnagel; Renato A Valdés Olmos Journal: Eur J Nucl Med Mol Imaging Date: 2009-01-13 Impact factor: 9.236
Authors: Min Yi; Funda Meric-Bernstam; Merrick I Ross; Jeri S Akins; Rosa F Hwang; Anthony Lucci; Henry M Kuerer; Gildy V Babiera; Michael Z Gilcrease; Kelly K Hunt Journal: Cancer Date: 2008-07-01 Impact factor: 6.860
Authors: Lincoln C Gray; Jayant S Vaidya; Michael Baum; Rajendra A Badwe; Indraneel Mittra; Tariq Siddiqui; Dorothea Wiarda Journal: World J Surg Date: 2004-06-08 Impact factor: 3.352
Authors: Regina M Fearmonti; Isis W Gayed; Edmund Kim; Isabelle Bedrosian; Kelly K Hunt; Funda Meric-Bernstam; Barry Feig; Elham Ghonimi; Carla Warneke; Gildy V Babiera Journal: Ann Surg Oncol Date: 2009-08-13 Impact factor: 5.344
Authors: Susanne H Estourgie; Omgo E Nieweg; Renato A Valdés Olmos; Emiel J Th Rutgers; Bin B R Kroon Journal: Ann Surg Date: 2004-02 Impact factor: 12.969
Authors: Iris M C van der Ploeg; Renato A Valdés Olmos; Bin B R Kroon; Emiel J T Rutgers; Omgo E Nieweg Journal: Eur J Nucl Med Mol Imaging Date: 2008-08-20 Impact factor: 9.236