Hong Ki Yong, Lee Han-Byoel, Yim Sangjun, Lee Jongho, Kim Tae-Yong, Han Wonshik, Jin Ung Sik
Department of Plastic and Reconstructive Surgery, Dongguk University Medical Center, Dongguk University School of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2017 Jul;24(7):1881-1888. doi: 10.1245/s10434-017-5837-z. Epub 2017 Mar 22.
This study was designed to explore the clinicopathological factors associated with internal mammary lymph node (IMN) metastasis in radiologically IMN-negative breast malignancies and to discuss the clinical value of opportunistic biopsy during immediate breast reconstruction using free flaps, where the internal mammary vessels are the recipient.
We retrospectively reviewed patients who received curative total mastectomy for breast malignancy followed by immediate reconstruction using transverse rectus abdominis myocutaneous (TRAM) free flap. Suspicious lymph nodes encountered during dissection of the third intercostal space for the recipient vessels were biopsied. Clinicopathological variables and the clinical impact associated with IMN metastasis were analyzed.
Among 269 patients who underwent immediate reconstruction using a TRAM free flap, suspicious lymph nodes were identified and biopsied in 54 (20.1%) patients, and IMN metastasis was confirmed in 12 (22.2%) of these (4.5% of all reconstructions). Five patients were positive despite negative axillary lymph nodes and 11 underwent therapeutic plan modifications. Multivariate analysis revealed that IMN metastasis was independently associated with medial tumor location, invasive tumor >2 cm, and positive human epidermal growth factor receptor-2 status (P < 0.05).
Aggressive IMN evaluation and biopsy in a subset of patients during immediate breast reconstruction using a TRAM free flap provided an additional opportunity for accurate breast cancer staging and appropriate adjuvant treatment, while minimizing unnecessary complications.
本研究旨在探讨在影像学检查显示内乳淋巴结（IMN）阴性的乳腺恶性肿瘤中，与IMN转移相关的临床病理因素，并讨论在以胸廓内血管为受区血管的游离皮瓣即刻乳房重建术中进行机会性活检的临床价值。
我们回顾性分析了因乳腺恶性肿瘤接受根治性全乳切除术并随后采用腹直肌肌皮（TRAM）游离皮瓣进行即刻重建的患者。在解剖第三肋间间隙以获取受区血管时遇到的可疑淋巴结进行活检。分析与IMN转移相关的临床病理变量及临床影响。
在269例行TRAM游离皮瓣即刻重建的患者中，54例（20.1%）患者发现可疑淋巴结并进行了活检，其中12例（22.2%）确诊为IMN转移（占所有重建病例的4.5%）。5例患者腋窝淋巴结阴性但IMN转移阳性，11例患者的治疗方案因此改变。多因素分析显示，IMN转移独立相关于肿瘤位于内侧、浸润性肿瘤>2 cm以及人表皮生长因子受体-2状态阳性（P<0.05）。
在采用TRAM游离皮瓣进行即刻乳房重建的部分患者中积极进行IMN评估和活检，为准确的乳腺癌分期及合适的辅助治疗提供了额外机会，同时将不必要的并发症降至最低。
