Benda Rashmi K, Cendan Juan C, Copeland Edward M, Feezor Robert J, Lind D Scott, Morris Christopher G, Mendenhall Nancy Price
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
Cancer. 2004 Feb 1;100(3):518-23. doi: 10.1002/cncr.11918.
Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment-related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment.
The authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation.
Lymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2-T4; P<0.0001) and positive lymph nodes (17 of 91 in lymph node-negative patients vs. 28 of 66 in lymph node-positive patients; P<0.0001). In patients with T2N0 tumors (n=32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]).
The incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement.
由于难以预测内乳淋巴结（IMN）转移、潜在的治疗相关并发症以及疗效存疑，IMN转移的治疗仍存在争议。前哨淋巴结活检的淋巴闪烁显像提供了一种识别IMN隐匿转移的方法，有助于为IMN治疗选择合适的患者。
作者回顾性分析了1998年至2002年间在佛罗里达大学（佛罗里达州盖恩斯维尔）接受治疗的248例患者的262次淋巴闪烁显像（LS）。评估肿瘤特征在预测IMN引流中的价值及其与IMN放疗的相关性。
262个肿瘤标本中有23个（9%）通过LS记录到淋巴流向IMN。淋巴流向IMN与以下五个因素均无相关性：肿瘤位置、肿瘤大小、淋巴管侵犯、病理淋巴结状态以及患侧乳房的侧别（右乳与左乳）。采用深部注射技术后，识别出的IMN淋巴引流从5.7%增加到10.1%。肿瘤较大的患者（Tis/T1期188例中的15例 vs. T2 - T4期70例中的31例；P<0.0001）和淋巴结阳性的患者（淋巴结阴性患者91例中的17例 vs. 淋巴结阳性患者66例中的28例；P<0.0001）更常接受IMN放疗。在T2N0期肿瘤患者（n = 32）中，内侧肿瘤患者（11例中的5例[45%]）比外侧肿瘤患者（21例中的4例[19%]）更常接受IMN放疗。
与其他LS和扩大根治性乳房切除术系列相比，当前LS技术记录到的淋巴流向IMN的发生率较低。当在LS上识别出IMN淋巴引流时，可获得前哨IMN的组织病理学信息。在缺乏组织病理学信息的情况下，治疗决策应继续基于已知与IMN隐匿转移相关的临床因素。
