Risk assessment of internal mammary lymph node metastasis and choice of irradiation of internal mammary lymphatic drainage area in breast cancer patients with negative internal breast lymph nodes on imaging.
10.3760/cma.j.cn112152-20210713-00510
- VernacularTitle:影像学检查内乳淋巴结阴性乳腺癌患者内乳淋巴结转移风险评估与内乳淋巴引流区照射取舍
- Author:
Cheng Lin YANG
1
;
Jian Bin LI
2
;
Wei WANG
3
;
Xue WANG
4
;
Ying Jie ZHANG
3
;
Qian SHAO
3
;
Jin Zhi WANG
3
Author Information
1. Graduate College, Shandong First Medical University and Shandong Academy of Sciences, Jinan 250117, China.
2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China.
3. The First Ward of Chest Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China.
4. Tianjin Normal University Hospital, Tianjin 300387, China.
- Publication Type:Journal Article
- Keywords:
Breast neoplasms;
Internal mammary lymph nodes;
Internal mammary node irradiation;
Lymph node metastasis
- MeSH:
Breast Neoplasms/pathology*;
Female;
Humans;
Lymph Nodes/pathology*;
Lymphatic Metastasis/pathology*;
Neoplasms, Second Primary/pathology*;
Retrospective Studies;
Risk Assessment;
Sentinel Lymph Node Biopsy/methods*
- From:
Chinese Journal of Oncology
2022;44(5):410-415
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. Methods: The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Results: Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. Conclusions: The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.
