PDF herunterladen
J Reconstr Microsurg 2022; 38(09): 721-726
DOI: 10.1055/s-0042-1744503
Original Article

Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: A Prospective Study

Benjamin D. Schultz
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Darren Sultan
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Grace Ha
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Alexander Gibstein
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Khang Nguyen
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Sarah L. Barnett 
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Rebecca C. Suydam
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Armen K. Kasabian
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Mark L. Smith
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Neil Tanna
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background Accurate assessment of regional lymph node basins is critical for oncological management of breast cancer. The internal mammary lymph node (IMLN) basin directly drains the medial pole of the breast, but biopsy is not commonly performed. While the axillary sentinel lymph node sample remains the standard of care, the majority of patients who have been found to have a positive IMLN biopsy have simultaneously had negative axillary sentinel lymph nodes. This study prospectively examines routine IMLN biopsy during microsurgical breast reconstruction.

Methods An IRB-approved study of routine IMLN biopsies in 270 consecutive patients who underwent microsurgical breast reconstruction was performed from July 1, 2018, to June 1, 2021. Recorded data included unilateral or bilateral breast reconstruction, unilateral or bilateral IMLN sampling, patient demographics, disease stage, and pathologic findings of IMLN.

Results The majority of patients, 240 of 270 patients (88.9%), had bilateral reconstruction. Overall, 5 out of 270 (1.9%) patients had positive IMLN; one of these patients had positive axillary sentinel lymph nodes. The IMLN biopsy results in two of the five patients affected the clinical course as they were upstaged and required chemoradiation.

Conclusion Direct visualization of the internal mammary lymph nodes during dissection of the recipient vessels for microsurgical breast reconstruction allows for convenient sampling, with minimal donor site morbidity and enhances the therapeutic management of patients in whom nodal involvement is present. As such, the authors recommend IMLN sampling.

Keywords

breast reconstruction - internal mammary lymph node - mastectomy - DIEP flap - microsurgery - flap

Note

This research was approved by the Hofstra/Northwell IRB department, IRB #: 18–0584




Publikationsverlauf

Eingereicht: 15. Oktober 2021

Angenommen: 20. Februar 2022

Artikel online veröffentlicht:
15. März 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American Cancer Society. How Common Is Breast Cancer?. Accessed November 26 th 2018. at: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
    PubMed
  • 2 National Comprehensive Cancer Network. NCCN Breast Cancer Clinical Practice Guidelines in Oncology (V. 3. 2014) Breast Cancer. Accessed October 4th, 2015 at: http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf
    PubMed
  • 3 Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR. Internal mammary nodes in breast cancer: diagnosis and implications for patient management – a systematic review. J Clin Oncol 2008; 26 (30) 4981-4989
    Suche in Google Scholar
  • 4 Wright EJ, Momeni A, Kraneburg UM. et al. Clinical Significance of Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: Review of 264 Cases. Plast Reconstr Surg 2016; 137 (06) 917e-922e
    CrossrefPubMedSuche in Google Scholar
  • 5 Andree C, Schmidt VJ, Munder BIJ. et al. 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 2012; 18 (10) CR605-CR610
    CrossrefPubMedSuche in Google Scholar
  • 6 Hofer SO, Rakhorst HA, Mureau MA, Moolenburgh SE, van Huizum MA, van Geel AN. Pathological internal mammary lymph nodes in secondary and tertiary deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg 2005; 55 (06) 583-586
    CrossrefPubMedSuche in Google Scholar
  • 7 Caudle AS, Yi M, Hoffman KE. et al. Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients. Ann Surg Oncol 2014; 21 (01) 60-65
    CrossrefPubMedSuche in Google Scholar
  • 8 Zucali R, Mariani L, Marubini E. et al. Early breast cancer: evaluation of the prognostic role of the site of the primary tumor. J Clin Oncol 1998; 16 (04) 1363-1366
    CrossrefPubMedSuche in Google Scholar
  • 9 Gaffney DK, Tsodikov A, Wiggins CL. Diminished survival in patients with inner versus outer quadrant breast cancers. J Clin Oncol 2003; 21 (03) 467-472
    CrossrefPubMedSuche in Google Scholar
  • 10 Gong J, Yu Y, Wu G, Lin C, Tu X. Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis. World J Surg Oncol 2019; 17 (01) 135
    CrossrefPubMedSuche in Google Scholar
  • 11 Veronesi U, Cascinelli N, Greco M. et al. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 1985; 202 (06) 702-707
    CrossrefPubMedSuche in Google Scholar
  • 12 Sugg SL, Ferguson DJ, Posner MC, Heimann R. Should internal mammary nodes be sampled in the sentinel lymph node era?. Ann Surg Oncol 2000; 7 (03) 188-192
    CrossrefPubMedSuche in Google Scholar
  • 13 Estourgie SH, Nieweg OE, Olmos RA, Rutgers EJ, Kroon BB. Lymphatic drainage patterns from the breast. Ann Surg 2004; 239 (02) 232-237
    CrossrefPubMedSuche in Google Scholar
  • 14 Bellon JR, Livingston RB, Eubank WB. et al. Evaluation of the internal mammary lymph nodes by FDG-PET in locally advanced breast cancer (LABC). Am J Clin Oncol 2004; 27 (04) 407-410
    CrossrefPubMedSuche in Google Scholar
  • 15 Long H, Lin Z, Situ D, Ma G, Zheng Y, Rong T. Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients. Breast 2011; 20 (02) 129-133
    CrossrefPubMedSuche in Google Scholar
  • 16 He Q, Jiang J, Yang X, Fan L, Guo M, Zhang Y. A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer. Breast 2008; 17 (06) 568-573
    CrossrefPubMedSuche in Google Scholar
  • 17 Choi JE. The Metastatic Rate of Internal Mammary Lymph Nodes When Metastasis of Internal Mammary Lymph Node Is Suspected on PET/CT. J Breast Cancer 2013; 16 (02) 202-207
    CrossrefPubMedSuche in Google Scholar
  • 18 Clarke M, Collins R, Darby S. et al; Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366 (9503): 2087-2106
    CrossrefPubMedSuche in Google Scholar
  • 19 Colleoni M, Zahrieh D, Gelber RD. et al. Site of primary tumor has a prognostic role in operable breast cancer: the international breast cancer study group experience. J Clin Oncol 2005; 23 (07) 1390-1400
    CrossrefPubMedSuche in Google Scholar
  • 20 Noushi F, Spillane AJ, Uren RF, Gebski V. Internal mammary lymph node metastasis in breast cancer: predictive models to assist with prognostic influence. Breast 2011; 20 (03) 278-283
    CrossrefPubMedSuche in Google Scholar
  • 21 Stefanik D, Goldberg R, Byrne P. et al. Local-regional failure in patients treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1985; 3 (05) 660-665
    CrossrefPubMedSuche in Google Scholar
  • 22 Recht A, Gray R, Davidson NE. et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999; 17 (06) 1689-1700
    CrossrefPubMedSuche in Google Scholar
  • 23 Veronesi U, Marubini E, Mariani L, Valagussa P, Zucali R. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer 1999; 35 (09) 1320-1325
    Suche in Google Scholar
  • 24 Veronesi U, Arnone P, Veronesi P. et al. The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series. Ann Oncol 2008; 19 (09) 1553-1560
    CrossrefPubMedSuche in Google Scholar
  • 25 Grant AL, Lutz KH, Temple-Oberle CF. Incidental Internal Mammary Nodes during Recipient Vessel Dissection in Breast Reconstruction: Are They Significant?. Plast Reconstr Surg Glob Open 2015; 2 (12) e276
    CrossrefPubMedSuche in Google Scholar
  • 26 Knight MAF, Nguyen DT, Kobayashi MR, Evans GRD, Cheng MH. Incidental positive internal mammary lymph nodes: a multiple international institutional investigation. J Reconstr Microsurg 2008; 24 (03) 197-202
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Wong KY, Yu JT, Mahler-Araujo B, Forouhi P, Malata CM. Opportunistic internal mammary lymph node biopsy during microvascular free flap breast reconstruction: a useful technique?. Int J Surg 2013; 11 (09) 1027-1028
    CrossrefPubMedSuche in Google Scholar
  • 28 Yu JT, Provenzano E, Forouhi P, Malata CM. An evaluation of incidental metastases to internal mammary lymph nodes detected during microvascular abdominal free flap breast reconstruction. J Plast Reconstr Aesthet Surg 2011; 64 (06) 716-721
    CrossrefPubMedSuche in Google Scholar
  • 29 Schaverien MV, Purdie CA, Munnoch DA. Clinical value of internal mammary lymph node metastases found incidentally during free flap recipient vessel exposure. Eur J Surg Oncol 2013; 39 (06) 608-612
    CrossrefPubMedSuche in Google Scholar
  • 30 American Cancer Society. Breast Cancer Stages. Accessed April 7 th 2019 at: https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/stages-of-breast-cancer.html
    PubMed
  • 31 Kronowitz SJ, Kuerer HM, Hunt KK. et al. Impact of sentinel lymph node biopsy on the evolution of breast reconstruction. Plast Reconstr Surg 2006; 118 (05) 1089-1099
    CrossrefPubMedSuche in Google Scholar
  • 32 Bunting PW, Cyr AE, Gao F, Margenthaler JA. Sentinel lymph node biopsy during prophylactic mastectomy: is there a role?. J Surg Oncol 2014; 109 (08) 747-750
    CrossrefPubMedSuche in Google Scholar