Galimberti Viviana, Veronesi Paolo, Arnone Paolo, De Cicco Concetta, Renne Giuseppe, Intra Mattia, Zurrida Stefano, Sacchini Virgilio, Gennari Roberto, Vento Annarita, Luini Alberto, Veronesi Umberto
Divisions of Senology, European Institute of Oncology, Milan, Italy.
Ann Surg Oncol. 2002 Nov;9(9):924-8. doi: 10.1007/BF02557532.
Involvement of the internal mammary chain lymph nodes (IMNs) is associated with worsened prognosis in breast cancer. Use of lymphoscintigraphy to visualize sentinel nodes reveals that IMNs often receive lymph from the area containing the tumor.
We biopsied IMNs in 182 patients because there was radiouptake to the IMNs or because the tumor was located in the medial portion of the breast. After tumor removal, pectoralis major fibers were divided to expose intercostal muscle. A portion of intercostal muscle adjacent to the sternum was removed. Lymph nodes and surrounding fatty tissue in the intercostal space were freed, removed, and analyzed histologically. The pleural cavity was breached in four cases (2.2%), with spontaneous resolution.
IMNs were found in 160 (88%) of 182 patients; 146 (94.4%) were negative and 14 (8.8%) were positive. The latter received internal mammary chain radiotherapy. The axilla was negative in 4 of 14 cases and positive in 10.
IMNs can be quickly and easily removed via the breast incision with insignificant risk and no increase in postoperative hospitalization. The patients with a positive IMN migrated from N0 (4 cases) or N1 (10 cases) to N3, prompting modification of both local (radiotherapy to internal mammary chain) and systemic treatment; without IMN sampling, they would have been understaged.
内乳链淋巴结（IMNs）受累与乳腺癌预后恶化相关。使用淋巴闪烁造影术可视化前哨淋巴结显示，IMNs常接收来自肿瘤所在区域的淋巴液。
我们对182例患者的IMNs进行活检，原因是IMNs有放射性摄取或肿瘤位于乳房内侧部分。肿瘤切除后，将胸大肌纤维分开以暴露肋间肌。切除胸骨旁一部分肋间肌。游离、切除肋间间隙的淋巴结及周围脂肪组织，并进行组织学分析。4例（2.2%）患者胸膜腔破裂，但自行愈合。
182例患者中有160例（88%）发现有IMNs；146例（94.4%）为阴性，14例（8.8%）为阳性。后者接受了内乳链放疗。14例中有4例腋窝淋巴结阴性，10例阳性。
通过乳房切口可快速、轻松地切除IMNs，风险极小，且术后住院时间无增加。IMN阳性患者从N0（4例）或N1（10例）分期升为N3，促使局部（内乳链放疗）和全身治疗方案的调整；若未进行IMN取样，这些患者的分期会被低估。
