Prognostic Significance of Tumor-Positive Internal Mammary Sentinel Lymph Nodes in Breast Cancer: A Multicenter Cohort Study

• Published in: Annals of surgical oncology Vol. 22; no. 13; pp. 4254 - 4262
• Main Authors: Madsen, Eva V. E., Aalders, Kim C., van der Heiden-van der Loo, Margriet, Gobardhan, Paul D., van Oort, Poultje M. P., van der Ent, Fred W., Rutgers, Emiel J. T., Valdés Olmes, Renato A., Elias, Sjoerd G., van Dalen, Thijs
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Axilla; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - mortality; Carcinoma, Ductal, Breast - secondary; Carcinoma, Ductal, Breast - surgery; Cohort Studies; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Oncology; Prognosis; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Surgery; Surgical Oncology; Survival Rate; Young Adult; Sentinel Lymph Node; Internal Mammary Lymph Node; Sentinel Lymph Node Biopsy; Isolate Tumor Cell; Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4535-y

Introduction The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest in lymphatic drainage to the internal mammary (IM) nodes. The clinical impact of tumor positive IM nodes is not completely clear. This study evaluated the incidence and impact on overall survival of metastatic IM SLNs. Methods Between 1997 and 2010, 3685 patients underwent surgery including SLNB for primary breast cancer following an intratumoral or peritumoral radioactive-tracer injection. The presence of lymph node metastases was categorized according to the TNM-classification. Cumulative overall survival was estimated and the influence of metastases in the IM nodes and other factors was assessed by Cox-regression-analysis. Results In 754 patients (20.5 %) ipsilateral IM lymph nodes were visualized on preoperative lymphoscintigraphy, retrieval rate of IM SLNs was 81.0 %. IM metastases were detected in 130 patients (21.3 % of retrieved SLNs and 3.5 % of all patients respectively). The presence of IM metastases was associated with axillary metastases ( p  < 0.001). After a median follow-up of 61.2 months, 10.9 % of patients had died. In a multivariate analysis IM metastases did not have a significant effect on overall survival [HR] 1.20; CI: 0.73–1.98. In patients without axillary metastases ( n  = 2398), the presence of IM metastases ( n  = 43) was associated with worse survival [HR] 2.68; 95 % CI: 1.30–5.54. Conclusion Overall, the presence of IM metastases did not effect overall survival independent of other prognostic factors including axillary metastases. However, the small subgroup of patients who had IM metastases alone had worse outcome than patients without any regional lymph node metastases.