Byrd D R, Dunnwald L K, Mankoff D A, Anderson B O, Moe R E, Yeung R S, Schubert E K, Eary J F
Department of General Surgery, University of Washington Medical Center, Seattle 98195, USA.
Ann Surg Oncol. 2001 Apr;8(3):234-40. doi: 10.1007/s10434-001-0234-y.
Metastases to internal mammary lymph nodes (IMN) may occur in patients with breast cancer and may alter treatment recommendations. The purpose of this study was to identify the frequency of IMN drainage in patients undergoing breast lymphoscintigraphy and sentinel lymph node dissection (SLND).
The combined technique of peritumoral injection of radiocolloid and Lymphazurin blue for SLND was performed on 220 patients. All patients underwent preoperative lymphoscintigraphy before SLND. Lesion location by quadrant included: 110 upper outer (UOQ), 49 lower outer (LOQ), 30 upper inner (UIQ), 24 lower inner (LIQ), and 7 central.
Drainage to any nodal basin was observed in 184 of 220 patients (84%). IMN drainage was documented in 37 of 220 (17%) of patients. IMN drainage without evidence of axillary drainage occurred in 2 of 220 patients(1%). Drainage to the IMN based on quadrant location of the lesion was as follows: UOQ, 10%; LOQ, 27%; UIQ, 17%; LIQ, 25%; and central, 29%.
Internal mammary lymph node drainage shown by breast lymphoscintigraphy is common. Tumors in all quadrants may drain to IMNs, although drainage is significantly more common from quadrants other than the UOQ. Further studies are needed to determine whether lymphoscintigraphy drainage patterns identify patients at the highest risk for IMN metastases who may benefit from radiotherapy.
乳腺癌患者可能发生内乳淋巴结转移，这可能会改变治疗建议。本研究的目的是确定接受乳腺淋巴闪烁显像和前哨淋巴结清扫术（SLND）的患者内乳淋巴结引流的频率。
对220例患者采用瘤周注射放射性胶体和亚甲蓝进行SLND的联合技术。所有患者在SLND术前均接受术前淋巴闪烁显像。按象限划分的病变位置包括：110例上外象限（UOQ）、49例下外象限（LOQ）、30例上内象限（UIQ）、24例下内象限（LIQ）和7例中央区。
220例患者中有184例（84%）观察到有任何淋巴结引流。220例患者中有37例（17%）记录到内乳淋巴结引流。220例患者中有2例（1%）出现内乳淋巴结引流而无腋窝引流证据。根据病变的象限位置，内乳淋巴结引流情况如下：UOQ为10%；LOQ为27%；UIQ为17%；LIQ为25%；中央区为29%。
乳腺淋巴闪烁显像显示的内乳淋巴结引流很常见。所有象限的肿瘤都可能引流至内乳淋巴结，尽管UOQ以外象限的引流更为常见。需要进一步研究以确定淋巴闪烁显像的引流模式是否能识别出可能从放疗中获益的内乳淋巴结转移高危患者。
