AIM: Using clinical data and results of lymphoscintigraphy to calculate probability of internal mammary lymph node (IMLN) invasion by breast cancer (BC). To evaluate clinical value of lymphoscintigraphy as the guide for irradiation of IMLN. METHODS: Using the data of eight published studies that analyzed lymph flow from primary BC (4541pts) after intra-peri-tumoral injection of nanosized 99mTc-colloids we determined probability of lymph-flow from internal-central and external BC to IMLN. In 7 studies (4359pts) axillary staging was accompanied by IMLN biopsy (911pts) that helped us to estimate probability of IMLN metastatic invasion in relation to the status of axillary LN. Finally, we estimated probability of IMLN invasion by BC in five randomized and observation studies that analyzed effect of IMLN irradiation on overall survival (OS). We calculated possible gain in survival if they would be treated according to lymph-flow guided radiotherapy to IMLN. RESULTS: Lymph-flow from internal/central BC to IMLN was mentioned in 35% from external lesions - in 16% cases. In women with negative axillary LN metastases in IMLN were revealed in 7.8%pts, in the case of positive axillary nodes average risk of IMLN invasion increased to 38.1%. Calculated probability of IMLN metastatic invasion in pts included in evaluated trials did not exceed 10%. If lymphoscintigraphy would drive decision about irradiation of IMLN than 72-78% of pts included in these studies would escape radiotherapy to IMLN. In the remaining 21-28%pts with lymph-flow to IMLN their irradiation probably would increase gain in OS from 1.0-3.3% to 4.3-16.8%. CONCLUSION: Lymphoscintigraphy can be used to optimize the strategy of IMLN irradiation.
AIM: Using clinical data and results of lymphoscintigraphy to calculate probability of internal mammary lymph node (IMLN) invasion by breast cancer (BC). To evaluate clinical value of lymphoscintigraphy as the guide for irradiation of IMLN. METHODS: Using the data of eight published studies that analyzed lymph flow from primary BC (4541pts) after intra-peri-tumoral injection of nanosized 99mTc-colloids we determined probability of lymph-flow from internal-central and external BC to IMLN. In 7 studies (4359pts) axillary staging was accompanied by IMLN biopsy (911pts) that helped us to estimate probability of IMLN metastatic invasion in relation to the status of axillary LN. Finally, we estimated probability of IMLN invasion by BC in five randomized and observation studies that analyzed effect of IMLN irradiation on overall survival (OS). We calculated possible gain in survival if they would be treated according to lymph-flow guided radiotherapy to IMLN. RESULTS: Lymph-flow from internal/central BC to IMLN was mentioned in 35% from external lesions - in 16% cases. In women with negative axillary LN metastases in IMLN were revealed in 7.8%pts, in the case of positive axillary nodes average risk of IMLN invasion increased to 38.1%. Calculated probability of IMLN metastatic invasion in pts included in evaluated trials did not exceed 10%. If lymphoscintigraphy would drive decision about irradiation of IMLN than 72-78% of pts included in these studies would escape radiotherapy to IMLN. In the remaining 21-28%pts with lymph-flow to IMLN their irradiation probably would increase gain in OS from 1.0-3.3% to 4.3-16.8%. CONCLUSION: Lymphoscintigraphy can be used to optimize the strategy of IMLN irradiation.
Authors: Robert A Olson; Ryan Woods; Caroline Speers; Jeffrey Lau; Andrea Lo; Pauline T Truong; Scott Tyldesley; Ivo A Olivotto; Lorna Weir Journal: Int J Radiat Oncol Biol Phys Date: 2012-02-16 Impact factor: 7.038
Authors: Timothy J Whelan; Ivo A Olivotto; Wendy R Parulekar; Ida Ackerman; Boon H Chua; Abdenour Nabid; Katherine A Vallis; Julia R White; Pierre Rousseau; Andre Fortin; Lori J Pierce; Lee Manchul; Susan Chafe; Maureen C Nolan; Peter Craighead; Julie Bowen; David R McCready; Kathleen I Pritchard; Karen Gelmon; Yvonne Murray; Judy-Anne W Chapman; Bingshu E Chen; Mark N Levine Journal: N Engl J Med Date: 2015-07-23 Impact factor: 91.245
Authors: Philip M Poortmans; Sandra Collette; Carine Kirkove; Erik Van Limbergen; Volker Budach; Henk Struikmans; Laurence Collette; Alain Fourquet; Philippe Maingon; Mariacarla Valli; Karin De Winter; Simone Marnitz; Isabelle Barillot; Luciano Scandolaro; Ernest Vonk; Carla Rodenhuis; Hugo Marsiglia; Nicola Weidner; Geertjan van Tienhoven; Christoph Glanzmann; Abraham Kuten; Rodrigo Arriagada; Harry Bartelink; Walter Van den Bogaert Journal: N Engl J Med Date: 2015-07-23 Impact factor: 91.245
Authors: R F Uren; R B Howman-Giles; J F Thompson; D Malouf; G Ramsey-Stewart; F W Niesche; S B Renwick Journal: J Nucl Med Date: 1995-10 Impact factor: 10.057