Guth Amber A, Mercado Cecilia, Roses Daniel F, Hiotis Karen, Skinner Kristin, Diflo Thomas, Cangiarella Joan
Department of Surgery, NYU School of Medicine, New York, NY 10016, USA.
Am J Surg. 2006 Oct;192(4):502-5. doi: 10.1016/j.amjsurg.2006.05.011.
Axillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease?
We reviewed the cancer center pathology database from 1991 to 2005 for all cases of breast cancer with IMLNs.
IMLNs were identified in 64 breast cancer patients, with metastatic spread in 20 patients, and benign IMLNs described in 44 patients. Positive IMLNs were associated with more aggressive disease, including higher rates of invasive versus noninvasive cancers (5% ductal carcinoma-in-situ [DCIS] with positive IMLNs vs. 23% with negative IMLNs), lymphovascular invasion (55% vs. 11%), and a higher rate of axillary lymph node involvement (72% vs. 18%). Patients with positive IMLNs were also more likely to undergo mastectomy (75% vs. 54%).
IMLN metastases are a marker for disease severity; recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLN is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection. Preoperative lymphoscintigraphy may help identify these extra-axillary metastases.
腋窝淋巴结状态仍是乳腺癌预后最重要的预测因素，治疗决策基于有无淋巴结疾病。乳腺内淋巴结（IMLNs）可能是区域播散的部位。这是否是疾病侵袭性更强的一个标志呢？
我们回顾了1991年至2005年癌症中心病理数据库中所有伴有IMLNs的乳腺癌病例。
在64例乳腺癌患者中发现了IMLNs，其中20例有转移播散，44例IMLNs为良性。阳性IMLNs与更具侵袭性的疾病相关，包括浸润性癌与非浸润性癌的比例更高（IMLNs阳性的导管原位癌[DCIS]为5%，阴性为23%）、淋巴管侵犯（55%对11%）以及腋窝淋巴结受累率更高（72%对18%）。IMLNs阳性的患者也更有可能接受乳房切除术（75%对54%）。
IMLNs转移是疾病严重程度标志；认识到这一点可能会影响辅助治疗的选择。IMLNs中存在转移性疾病与腋窝淋巴结受累率高相关，应进行腋窝清扫术。术前淋巴闪烁显像可能有助于识别这些腋窝外转移。
