Value of Internal Mammary Lymph Node in Staging and Adjuvant Therapy of Breast Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HEQing-qing , HOULei , FANZi-yi , ZHUANGDa-yong , ZHENGLu-ming , XIAOLei , YUFang , ZHOUPeng , ZHUJian , ZHAOGuo-wei

Department of Thyroid and Breast Surgery, Jinan Military General Hospital, Jinan 250031, Shandong Province, China;

Corresponding author：

HEQing-qing, Email: heqingqing@yeah.Net

Keywords：

Breast cancer; Internal mammary lymph node; Biopsy; Metastasis; Staging; Radiotherapy

DOI：

10.7507/1007-9424.20140133

Video：

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Objective To analyze the value of internal mammary lymph node biopsy via intercostal space in staging and adjuvant therapy of breast cancer. Methods The clinical data of 305 breast cancer patients received any kind of radical mastectomy from may 2003 to January 2014 in the Jinan Military General Hospital of PLA were analyzed retrospectively. The patient age, axillary lymph node, and internal mammary lymph node status were integrated to investigate the changing of staging and postoperative adjuvant therapy of the breast cancer. Results These 305 patients were divided into neoadjuvant chemotherapy group and non-neoadjuvant therapy group. There were 67 patients in the neoadjuvant chemotherapy group, including 45(67.2%) patients with axillary lymph node positive, 23(34.3%) patients with internal mammary lymph node positive. There were 23(34.3%) patients who had a change of pathology lympy node (pN) staging and 8(11.9%) patients who had a change of the pTNM staging. Meanwhile, there were 238 patients in the non-neoadjuvant chemotherapy group, including 155(65.1%) patients with axillary lymph node positive, 30(12.6%) patients with internal mammary node positive. There were 30(12.6%) patients who had a change of the pN staging and 23(9.66%) patients who had a change of the pTNM staging. There was a significant difference in the metastasis rate of the internal mammary lymph node (χ²=15.7, P < 0.05) or the changing ratio of the pTNM staging (χ²=5.3, P < 0.05) in two groups. Conclusions Internal mammary lymph node status could affect pN staging of breast cancer, so do the pTNM staging (TNM, pathology tumor, lymph node, metastasis). The internal mammary lymph node status could guide the postoperative adjuvant radiative therapy by reducing excessive treatment of the internal mammary lymph node area, also could enhance the individual accurate therapy.

Citation： HEQing-qing, HOULei, FANZi-yi, ZHUANGDa-yong, ZHENGLu-ming, XIAOLei, YUFang, ZHOUPeng, ZHUJian, ZHAOGuo-wei. Value of Internal Mammary Lymph Node in Staging and Adjuvant Therapy of Breast Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(5): 549-553. doi: 10.7507/1007-9424.20140133 Copy

1.	贺青卿, 姜军, 杨新华, 等.经肋间隙取内乳区前哨淋巴结活检术的临床意义(附51例报告)[J].中国实用外科杂志, 2005, 25(6):350-352.
2.	Madsen EVE, Gobardhan PD, Bonges V, et al.The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer[J].Ann Surg Oncol, 2007, 14(4):1486-1492.
3.	Lee SK, Kim S, Choi MY, et al.The clinical meaning of intramammary lymph nodes[J].Oncology, 2013, 84(1):1-5.
4.	He Q, Zhuang D, Zheng L, et al.Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer:a randomized clinical study[J].Clin Breast Cancer, 2012, 12(6):454-458.
5.	Veronesi U, Cascinelli N, Greco M, et al.Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes[J].Ann Surg, 1985, 202(6):702-707.
6.	Fowble B.Local-regional treatment options for early invasive breast cancer[A]//Fowble B, Goodman RL, Glick JH, eds.Breast cancer treatment, a comprehensive guided to management[M].St.Louis:Mosby, 1991:72.
7.	Veronesi U, Marubini E, Mariani L, et al.The dissection of internal mammary nodes does not improve the survival of breast cancer patients.30-year results of a randomised trial[J].Eur J Cancer, 1999, 35(9):1320-1325.
8.	Budach W, Kammers K, Boelke E, et al.Adjuvant radiotherapy of regional lymph nodes in breast cancer-a meta-analysis of randomized trials[J].Radiat Oncol, 2013, 8:267.
9.	Li Z, Gu X, Tong J, et al.A meta-analysis of internal mammary lymph node metastasis in breast cancer patients[J].Onkologie, 2013, 36(12):747-752.
10.	Vrana D, Gatek J, Cwiertka K, et al.Internal mammary node management in breast cancer.A review[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2013, 157(3):261-265.
11.	黄欧, 凌泓, 沈坤炜, 等.1679例乳腺癌内乳淋巴结转移的高危因素分析[J].中国实用外科杂志, 2006, 26(4):270-274.
12.	Huang O, Wang LP, Shen KW, et al.Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis:analysis of 2269 Chinese breast cancer patients treated with extended radical mastectomy[J].Breast Cancer Res Treat, 2008, 107(3):379-387.
13.	Clarke M, Collins R, Darby S, et al.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[J].Lancet, 2005, 366(953):2087-2106.
14.	Whelan TJ, Olivotto I, Ackerman I, et al.NCIC-CTG MA.20:An intergroup trial of regional nodal irradiation in early breast cancer[J].J Clin Oncol (Meeting Abstracts), 2011, 29(18_suppl LBA1003).
15.	Overgaard M, Nielsen HM, Overgaard J.Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials[J].Radiother Oncol, 2007, 82(3):247-253.
16.	Gradishar WJ, Anderson BO, Blair SL, et al.NCCN Clinical Practice Guidelines in Oncology breast carcinoma-Version 1.2014[EB/OL].Nation Comprehensive Cancer Network.Available at:http://www.NCCN.org.
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(2):202-207.
18.	He Q, Zhuang D, Tian J, et al.Surgical approach to internal mammary sentinel node biopsy[J].J Invest Surg, 2010, 23(6):321-326.
19.	He Q, Jiang J, Yang X, et al.A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer[J].Breast, 2008, 17(6):568-573.
20.	贺青卿, 庄大勇, 郑鲁明, 等.乳腺癌内乳淋巴结病理状态的再认识:附229例内乳淋巴结活检报告[J].中华内分泌外科杂志, 2011, 5(5):335-339.
21.	贺青卿, 杨新华, 郭美琴, 等.胸腔镜内乳淋巴链清扫术的临床研究[J].第三军医大学学报, 2005, 27(22):2290-2292.
22.	贺青卿, 姜军, 杨新华, 等.经肋间隙入路行内乳淋巴结活检的探讨[J].中华普通外科杂志, 2006, 21(9):634-636.
23.	Edge SB, Byrd DR, Compton CC, et al.eds.AJCC Cancer Staging Manual[M].7th Edition.New York:Springer, 2010.

1. 贺青卿, 姜军, 杨新华, 等.经肋间隙取内乳区前哨淋巴结活检术的临床意义(附51例报告)[J].中国实用外科杂志, 2005, 25(6):350-352.
2. Madsen EVE, Gobardhan PD, Bonges V, et al.The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer[J].Ann Surg Oncol, 2007, 14(4):1486-1492.
3. Lee SK, Kim S, Choi MY, et al.The clinical meaning of intramammary lymph nodes[J].Oncology, 2013, 84(1):1-5.
4. He Q, Zhuang D, Zheng L, et al.Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer:a randomized clinical study[J].Clin Breast Cancer, 2012, 12(6):454-458.
5. Veronesi U, Cascinelli N, Greco M, et al.Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes[J].Ann Surg, 1985, 202(6):702-707.
6. Fowble B.Local-regional treatment options for early invasive breast cancer[A]//Fowble B, Goodman RL, Glick JH, eds.Breast cancer treatment, a comprehensive guided to management[M].St.Louis:Mosby, 1991:72.
7. Veronesi U, Marubini E, Mariani L, et al.The dissection of internal mammary nodes does not improve the survival of breast cancer patients.30-year results of a randomised trial[J].Eur J Cancer, 1999, 35(9):1320-1325.
8. Budach W, Kammers K, Boelke E, et al.Adjuvant radiotherapy of regional lymph nodes in breast cancer-a meta-analysis of randomized trials[J].Radiat Oncol, 2013, 8:267.
9. Li Z, Gu X, Tong J, et al.A meta-analysis of internal mammary lymph node metastasis in breast cancer patients[J].Onkologie, 2013, 36(12):747-752.
10. Vrana D, Gatek J, Cwiertka K, et al.Internal mammary node management in breast cancer.A review[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2013, 157(3):261-265.
11. 黄欧, 凌泓, 沈坤炜, 等.1679例乳腺癌内乳淋巴结转移的高危因素分析[J].中国实用外科杂志, 2006, 26(4):270-274.
12. Huang O, Wang LP, Shen KW, et al.Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis:analysis of 2269 Chinese breast cancer patients treated with extended radical mastectomy[J].Breast Cancer Res Treat, 2008, 107(3):379-387.
13. Clarke M, Collins R, Darby S, et al.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[J].Lancet, 2005, 366(953):2087-2106.
14. Whelan TJ, Olivotto I, Ackerman I, et al.NCIC-CTG MA.20:An intergroup trial of regional nodal irradiation in early breast cancer[J].J Clin Oncol (Meeting Abstracts), 2011, 29(18_suppl LBA1003).
15. Overgaard M, Nielsen HM, Overgaard J.Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials[J].Radiother Oncol, 2007, 82(3):247-253.
16. Gradishar WJ, Anderson BO, Blair SL, et al.NCCN Clinical Practice Guidelines in Oncology breast carcinoma-Version 1.2014[EB/OL].Nation Comprehensive Cancer Network.Available at:http://www.NCCN.org.
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(2):202-207.
18. He Q, Zhuang D, Tian J, et al.Surgical approach to internal mammary sentinel node biopsy[J].J Invest Surg, 2010, 23(6):321-326.
19. He Q, Jiang J, Yang X, et al.A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer[J].Breast, 2008, 17(6):568-573.
20. 贺青卿, 庄大勇, 郑鲁明, 等.乳腺癌内乳淋巴结病理状态的再认识:附229例内乳淋巴结活检报告[J].中华内分泌外科杂志, 2011, 5(5):335-339.
21. 贺青卿, 杨新华, 郭美琴, 等.胸腔镜内乳淋巴链清扫术的临床研究[J].第三军医大学学报, 2005, 27(22):2290-2292.
22. 贺青卿, 姜军, 杨新华, 等.经肋间隙入路行内乳淋巴结活检的探讨[J].中华普通外科杂志, 2006, 21(9):634-636.
23. Edge SB, Byrd DR, Compton CC, et al.eds.AJCC Cancer Staging Manual[M].7th Edition.New York:Springer, 2010.

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Value of Internal Mammary Lymph Node in Staging and Adjuvant Therapy of Breast Cancer

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