Internal mammary node

Interest in evaluating internal mammary nodes (IMNs) has recently been rejuvenated with the advent and widespread acceptance of lymphatic mapping and SLNB in breast cancer. The lymphoscintiscan demonstrates mapping to IMNs in 0-35% patients (61-63). In contrast to traditional thinking, internal mammary drainage can occur with tumours in any quadrant (61). Most patients with drainage to internal mammary nodes also have axillary drainage and surgeons are reluctant to perform internal mammary lymph node biopsies even if drainage to this site is demonstrated because this procedure is not performed currently. Determination of internal mammary nodal involvement may alter adjuvant therapy. However, this represents <1% of patients as few patients have an internal mammary SLN

containing metastatic cancer when the axillary SLN is negative (61, 63). Moreover, many patients currently receive adjuvant systemic therapy based upon tumour characteristics (size and grade), even if node negative. The fact that IMN dissection does not improve survival (64) poses a problem for indication of adjuvant radiotherapy to this basin. The effect on survival of radiation therapy on the internal mammary chain is the subject of the ongoing EORTC 22922 trial. Therefore, internal mammary sentinel lymph node biopsy is not recommended in patients with drainage to this basin.

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