Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 519
© 2005 American Society of Clinical Oncology

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Abstract

Clinical relevance of internal mammary node drainage in sentinel node biopsy for breast cancer

Dept of Surg, Cardiff Univ, Cardiff, United Kingdom; Dept of Statistics, Cardiff Univ, Cardiff, United Kingdom

519

Background: This study was designed to identify the frequency of internal mammary(IM) drainage in patients undergoing sentinel node biopsy(SNB) in a controlled clinical trial. The clinical relevance of internal mammary SNB as a method to improve nodal staging and treatment in breast cancer is investigated. Methods: A total of 1,139 patients with invasive breast cancer underwent SNB based on a standardised protocol using Tc 99m albumin colloid and Patent Blue V injected peritumorally. In 707 patients who participated in the validation phase, SNB was followed by standard axillary treatment in the same operation. Results: Lymphoscintigraphy showed IM sentinel nodes in 106 patients(9%), and IM drainage was identified perioperatively in an additional 14 patients(1%) using the gamma probe. Sampling of the IM basin, was done in 60 of the 120 patients (50%) with IM drainage. Three patients had a pneumothorax and 3 experienced bleeding during IM sampling. IM metastases were detected in 8 of the 60 patients(13%). In 5 patients, IM nodes showed metastatic involvement without accompanying axillary metastases. Four of these patients(7%, 4/60) would have received adjuvant endocrine systemic therapy because of the characteristics of the tumor, but may not have been recommended to receive adjuvant systemic chemotherapy. Therefore, overall a change in management occurred in only 0.7% of patients in our series(7% of the 10% patients with IM node drainage), but 46 patients with unbiopsied "hot" IM nodes remained with unknown internal mammary status. Conclusion: The impact of internal mammary SNB on indication for adjuvant treatment is low and it may be associated with some additional morbidity. Current evidence suggests that internal mammary SNB is still a research tool.

No significant financial relationships to disclose.

Abstract presentation from the 2005 ASCO Annual Meeting