Internal mammary sentinel nodes: ignore, irradiate or operate?

Coombs, Nathan J., Boyages, John, French, James R. and Ung, Owen A. (2009) Internal mammary sentinel nodes: ignore, irradiate or operate?. European Journal of Cancer, 45 5: 789-794. doi:10.1016/j.ejca.2008.11.002

Author Coombs, Nathan J.
Boyages, John
French, James R.
Ung, Owen A.
Title Internal mammary sentinel nodes: ignore, irradiate or operate?
Journal name European Journal of Cancer   Check publisher's open access policy
ISSN 0959-8049
Publication date 2009-01-01
Sub-type Article (original research)
DOI 10.1016/j.ejca.2008.11.002
Open Access Status Not yet assessed
Volume 45
Issue 5
Start page 789
End page 794
Total pages 6
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Language eng
Formatted abstract
Introduction: This study describes the results of internal mammary chain (IMC) biopsy, identifying factors that predict 'hot spots' and nodal metastases for patients in whom mapped IMC nodes were routinely dissected.

Methods: The nodal basin and status of every axillary and IMC site identified by lymphoscintigraphy were examined. Binary logistic regression analysed the relationship of several patients and tumour factors with IMC hot spots and metastases.

Results: Ninety of 490 patients (18.4%) had IMC sentinel lymph nodes (SLNs) identified by lymphatic mapping and dissected, and 20 of these (22.2%) were found to have metastases. Mapping to the IMC was most likely for women aged under 35 years (29.4%) (p = 0.117), women aged 35-44 (22.6%) (p = 0.034) or those with medial (23.7%) or central tumour location (22.2%) (p = 0.014; p = 0.062, respectively). Predictors of IMC positivity included age <35 years (p = 0.063), grade 3 histology (p = 0.018) and lymphatic vascular invasion (LVI) (p = 0.032). Although IMC positivity was more likely with positive axillary nodes, this trend was not significant.

Conclusion: We identified several factors (age <35 years, tumour grade and LVI) that independently predict IMC SLN identification and positivity for patients with stage I or II breast cancer. Where IMC hot spots are not dissected, we predict IMC positivity of 50% or more for young women (<35 years) or women with high grade or LVI positive tumours, and these women may benefit from more intensive chemotherapy and radiotherapy to the IMC. 
Keyword Breast neoplasms
Internal mammary nodes
Lymph node excision
Sentinel lymph node biopsy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 29 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 30 times in Scopus Article | Citations
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Created: Thu, 12 Jun 2014, 20:17:07 EST by Ms Kate Rowe on behalf of School of Medicine