BACKGROUND: Internal mammary (IM) nodes are a potential site of breast lymphatic drainage. We examined the relationship between lymphoscintigraphic evidence of IM drainage and survival in early-stage breast cancer patients (pts). METHODS: From a prospective database of 855 consecutive sentinel node mapping procedures using peritumoral radiocolloid injection from 1996-2004, we analyzed the 604 cases with stage I-III breast cancer. Overall survival and recurrence-free survival (OS, RFS) rates were compared in pts with (IM+) and without (IM-) IM drainage on lymphoscintigraphy using Kaplan-Meier plots and Cox proportional hazards models. RESULTS: 100 of 604 pts (17%) showed IM drainage. Five-year OS and RFS were 92% vs 88% and 88% vs 85% in IM- vs IM+ pts. In the 186 pts with axillary metastases (node+), 5-year OS and RFS were 91% vs 71% and 84% vs 69% in IM- vs IM+ pts. Univariate analysis of node+ pts estimated increased mortality risk for IM+ (hazard ratio, HR 2.9, P = .04), >or=4 positive nodes (HR 3.2, P = .02), tumors that were ER-negative (HR 3.4, P = .02), or had high Ki-67 (HR 6.8, P = .01). Multivariate analysis estimated similar increased risks [>or=4 nodes (HR 4.0, P = .02), IM+ (HR 3.3, P = .06), and ER negativity (HR 2.6, P = .09)]. CONCLUSIONS: IM nodal drainage predicted a nearly 3-fold increased mortality risk in node+ pts. Peritumoral radiocolloid injection provides a clinically relevant assessment of IM drainage and should be prospectively tested for its value in tailoring treatment strategies for axillary node-positive pts.
BACKGROUND: Internal mammary (IM) nodes are a potential site of breast lymphatic drainage. We examined the relationship between lymphoscintigraphic evidence of IM drainage and survival in early-stage breast cancerpatients (pts). METHODS: From a prospective database of 855 consecutive sentinel node mapping procedures using peritumoral radiocolloid injection from 1996-2004, we analyzed the 604 cases with stage I-III breast cancer. Overall survival and recurrence-free survival (OS, RFS) rates were compared in pts with (IM+) and without (IM-) IM drainage on lymphoscintigraphy using Kaplan-Meier plots and Cox proportional hazards models. RESULTS: 100 of 604 pts (17%) showed IM drainage. Five-year OS and RFS were 92% vs 88% and 88% vs 85% in IM- vs IM+pts. In the 186 pts with axillary metastases (node+), 5-year OS and RFS were 91% vs 71% and 84% vs 69% in IM- vs IM+pts. Univariate analysis of node+ pts estimated increased mortality risk for IM+ (hazard ratio, HR 2.9, P = .04), >or=4 positive nodes (HR 3.2, P = .02), tumors that were ER-negative (HR 3.4, P = .02), or had high Ki-67 (HR 6.8, P = .01). Multivariate analysis estimated similar increased risks [>or=4 nodes (HR 4.0, P = .02), IM+ (HR 3.3, P = .06), and ER negativity (HR 2.6, P = .09)]. CONCLUSIONS: IM nodal drainage predicted a nearly 3-fold increased mortality risk in node+ pts. Peritumoral radiocolloid injection provides a clinically relevant assessment of IM drainage and should be prospectively tested for its value in tailoring treatment strategies for axillary node-positive pts.
Authors: Amanda L Kong; Welela Tereffe; Kelly K Hunt; Min Yi; Taewoo Kang; Kimberly Weatherspoon; Elizabeth A Mittendorf; Isabelle Bedrosian; Rosa F Hwang; Gildy V Babiera; Thomas A Buchholz; Funda Meric-Bernstam Journal: Cancer Date: 2012-05-30 Impact factor: 6.860
Authors: Min Young Koo; Se Kyung Lee; Soo Youn Bae; Min-Young Choi; Dong Hui Cho; Sangmin Kim; Jeong Eon Lee; Seok Jin Nam; Jung-Hyun Yang Journal: J Breast Cancer Date: 2012-03-28 Impact factor: 3.588
Authors: Alfredo Carlos S D Barros; Lincon Jo Mori; Dolores Nishimura; Alfredo L Jacomo Journal: World J Surg Oncol Date: 2016-04-30 Impact factor: 2.754