REVIEW ARTICLES  THE REPRODUCTIVE SYSTEM
Guest Editors: Freeman L. M., Bombardieri E. 

The Quarterly Journal of Nuclear Medicine 2002 June;46(2):138-44

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Internal mammary node lymphoscintigraphy and biopsy in breast cancer

Paganelli G., Galimberti V. **, Trifirò G., Travaini L., De Cicco C., Mazzarol G. *, Intra M. **, Rocca P., Prisco G., Veronesi U. **

Divisions of Nuclear Medicine and *Pathology **Breast Surgery Unit, European Institute of Oncology, Milan, Italy

Background. In ­patients ­with ­breast can­cer, sen­ti­nel ­nodes (SNs) are detect­ed out­side the axil­la in 1-2% of cas­es ­after super­fi­cial injec­tion of radio­col­loid in the ­breast. We inves­ti­gat­ed wheth­er ­deep injec­tion of trac­er vis­u­al­ized inter­nal mam­mary ­chain ­lymph (IMC) ­nodes ­more ­often, and ­assessed the ­impact of IMC stat­us on dis­ease stag­ing.
Methods. A ­total of 400 ­patients ­were ­enrolled in ­this ­trial. The ­study ­group includ­ed 200 ­patients ­with T1-T2 N0 ­breast can­cer in an ­inner quad­rant. Radio trac­er was inject­ed super­fi­cial­ly in 100 (­group A), and deep­ly ­under the ­tumor in the oth­ers (­group B). If an IMC ­took up trac­er in ­group B ­patients it was biop­sied. An addi­tion­al 200 ­patients ­with out­er quad­rant ­lesions ­were ­also stud­ied lym­phos­cin­ti­graph­i­cal­ly fol­low­ing super­fi­cial (100 ­patients) or ­deep (100 ­patients) injec­tion, but IMC ­nodes ­were not biop­sied as ­this ­would ­have ­required an addi­tion­al sur­gi­cal exci­sion.
Results. An SN was vis­u­al­ized in the IMC in 65.6% of ­inner quad­rant ­patients ­after ­deep injec­tion and in 2.1% ­after super­fi­cial injec­tion. In out­er quad­rant ­patients, ­deep injec­tion vis­u­al­ized an SN in the IMC in 10% of cas­es. The IMC SN was locat­ed main­ly in the 2nd and 3rd inter­cos­tal spac­es. Radioguided IMC biop­sy was per­formed in 62 ­patients. Node remov­al ­proved sim­ple and ­risks insig­nif­i­cant. Stage migra­tion ­occurred in 8% of cas­es.
Conclusions. Deep injec­tion ­allows SN local­iza­tion in the IMC in 65% of ­inner quad­rant ­breast ­lesions. Biopsy of the axil­lary ­plus IMC result­ed in ­stage migra­tion in 8% of ­patients. It is ­unclear wheth­er ­this addi­tion­al infor­ma­tion can ­lead to bet­ter sur­vi­val.