Clinical significance of internal mammary lymph node metastasis for breast cancer: Analysis of 337 breast cancer patients

Xiao-Wei Qi; Jun-Ze Du; Peng Tang; Xue Liu; Qing-Qing He; Ling Zhong; Xiu-Wu Bian; Jun Jiang

doi:10.1016/j.suronc.2018.03.006

Clinical significance of internal mammary lymph node metastasis for breast cancer: Analysis of 337 breast cancer patients

Surg Oncol. 2018 Jun;27(2):185-191. doi: 10.1016/j.suronc.2018.03.006. Epub 2018 Mar 27.

Authors

Xiao-Wei Qi¹, Jun-Ze Du¹, Peng Tang¹, Xue Liu², Qing-Qing He¹, Ling Zhong¹, Xiu-Wu Bian³, Jun Jiang⁴

Affiliations

¹ Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
² Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
³ Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. Electronic address: bianxiuwu@263.net.
⁴ Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. Electronic address: jcbd@medmail.com.cn.

PMID: 29937170
DOI: 10.1016/j.suronc.2018.03.006

Abstract

Purpose: Internal mammary nodes (IMNs) is a major pathway of lymphatic drainage for breast cancer, apart from axillary lymph node (ALN). However, owing to lack of a feasible and safe biopsy method, management of IMNs is still controversial in breast surgery.

Methods: From 2005 to 2009, a total of 337 consecutive breast cancer women patients were recruited. All patients underwent IMNs biopsy through intercostal space or endoscopic lymphatic chain resection. The ER, PR and HER-2 status were retested according to the current ASCO/CAP guidelines. We analyzed the relationship between clinical pathological parameters and IMNs metastasis and investigated the high risk factors and prognostic values of IMNs metastasis in breast cancer.

Results: Among 337 patients, 314 patients underwent intercostal space IMNs biopsy and 23 patients underwent endoscopic lymphatic chain resection. A total of 63 (18.69%) patients were pathologically diagnosed with IMNs metastasis. Among them, 28 (44.44%) patients changed the pathological lymph node staging, and 15 cases (23.81%) changed the postoperative comprehensive treatment program and accepted extended postoperative radiotherapy. Multivariate analysis showed that compared with no ALN involvement, the risk of IMNs metastasis was significantly increased in patients with 1-3 ALN involvement (OR = 42.097, 95% CI = 5.225-339.178; P = 0.0004) and ≥4 ALN involvement (OR = 82.429, 95%CI = 10.134-670.496; P < 0.0001). The risk of IMNs metastasis in HER-2 positive patients was significantly higher than that in negative patients (OR = 5.452, 95% CI = 2.353-12.634; P < 0.0001). However, we did not find IMNs involvement was an independent indicator for both overall survival and disease-free survival.

Conclusions: Our clinical practice and data indicated that IMNs biopsy through intercostal space and endoscopic lymphatic chain resection are effective and minimally invasive methods to detect the IMNs status, which may be helpful for accurate tumor staging, risk assessment and option of chemotherapy or radiotherapy to improve the patients' survival.

Keywords: Biopsy; Breast cancer; Internal mammary nodes; Prognosis; Risk factor.

MeSH terms

Adult
Aged
Breast Neoplasms / secondary*
Breast Neoplasms / surgery
Female
Follow-Up Studies
Humans
Lymph Nodes / pathology*
Lymph Nodes / surgery
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local / pathology*
Neoplasm Recurrence, Local / surgery
Neoplasm Staging
Sentinel Lymph Node Biopsy
Survival Rate
Young Adult