Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification?

BACKGROUND Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment‐related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult invol...

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Bibliographic Details
Published in:Cancer 2004-02, Vol.100 (3), p.518-523
Main Authors: Benda, Rashmi K., Cendan, Juan C., Copeland, Edward M., Feezor, Robert J., Lind, D. Scott, Morris, Christopher G., Mendenhall, Nancy Price
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Needle
breast neoplasms
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - pathology
Breast Neoplasms - therapy
Cohort Studies
drainage
Drainage - methods
Female
Follow-Up Studies
Humans
lymph nodes
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Lymphatic Irradiation - standards
Lymphatic Irradiation - trends
Lymphatic Metastasis
Medical sciences
Middle Aged
Neoplasm Staging
Probability
Radionuclide Imaging
radiotherapy
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Survival Analysis
Treatment Outcome
Tumors
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Summary:BACKGROUND Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment‐related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment. METHODS The authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation. RESULTS Lymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2–T4; P < 0.0001) and positive lymph nodes (17 of 91 in lymph node–negative patients vs. 28 of 66 in lymph node–positive patients; P < 0.0001). In patients with T2N0 tumors (n = 32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]). CONCLUSIONS The incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement. Cancer 2004. © 2003 American Cancer Society. Despite the well documented prognostic significance of internal mammary lymph node (IMN) metastases, treatment of IMN remains controversial because of potential treatment‐related morbidity and questionable efficacy. In the absence of histopathologic information, treatment decisions should be based on clinical information that is known to be correlated with occult involvement of IMNs. The findings of the current study suggest that IMN flow may not always be identified by lymphoscintigraphy.
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.11918