Discussion on the indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine

Yongsheng WANG; Rongrong ZHAO; Yanbing LIU; Peng CHEN; Tong ZHAO; Xiao SUN; Chunjian WANG; Zhaopeng ZHANG; Zhiqiang SHI; Pengfei QIU

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Discussion on the indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine

VernacularTitle: 精准医学时代乳腺癌内乳前哨淋巴结活检适应证的探讨
Author: Yongsheng WANG ¹ ; Rongrong ZHAO ² ; Yanbing LIU ¹ ; Peng CHEN ¹ ; Tong ZHAO ¹ ; Xiao SUN ¹ ; Chunjian WANG ¹ ; Zhaopeng ZHANG ¹ ; Zhiqiang SHI ¹ ; Pengfei QIU ¹
Author Information

1. Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
2. Department of Medicine, Shandong Cancer Hospital and Institute, Jinan 250117, China
Publication Type:Journal Article
Keywords: Breast neoplasms; Internal mammary sentinel lymph node biopsy; Axillary lymph node
From: Chinese Journal of Oncology 2019;41(4):251-256
CountryChina
Language:Chinese
Abstract: Objective:To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications.
Methods:All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines.
Results:Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy.
Conclusions:IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.