Qi Xiao-Wei, Du Jun-Ze, Tang Peng, Liu Xue, He Qing-Qing, Zhong Ling, Bian Xiu-Wu, Jiang Jun
Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Surg Oncol. 2018 Jun;27(2):185-191. doi: 10.1016/j.suronc.2018.03.006. Epub 2018 Mar 27.
Internal mammary nodes (IMNs) is a major pathway of lymphatic drainage for breast cancer, apart from axillary lymph node (ALN). However, owing to lack of a feasible and safe biopsy method, management of IMNs is still controversial in breast surgery.
From 2005 to 2009, a total of 337 consecutive breast cancer women patients were recruited. All patients underwent IMNs biopsy through intercostal space or endoscopic lymphatic chain resection. The ER, PR and HER-2 status were retested according to the current ASCO/CAP guidelines. We analyzed the relationship between clinical pathological parameters and IMNs metastasis and investigated the high risk factors and prognostic values of IMNs metastasis in breast cancer.
Among 337 patients, 314 patients underwent intercostal space IMNs biopsy and 23 patients underwent endoscopic lymphatic chain resection. A total of 63 (18.69%) patients were pathologically diagnosed with IMNs metastasis. Among them, 28 (44.44%) patients changed the pathological lymph node staging, and 15 cases (23.81%) changed the postoperative comprehensive treatment program and accepted extended postoperative radiotherapy. Multivariate analysis showed that compared with no ALN involvement, the risk of IMNs metastasis was significantly increased in patients with 1-3 ALN involvement (OR = 42.097, 95% CI = 5.225-339.178; P = 0.0004) and ≥4 ALN involvement (OR = 82.429, 95%CI = 10.134-670.496; P < 0.0001). The risk of IMNs metastasis in HER-2 positive patients was significantly higher than that in negative patients (OR = 5.452, 95% CI = 2.353-12.634; P < 0.0001). However, we did not find IMNs involvement was an independent indicator for both overall survival and disease-free survival.
Our clinical practice and data indicated that IMNs biopsy through intercostal space and endoscopic lymphatic chain resection are effective and minimally invasive methods to detect the IMNs status, which may be helpful for accurate tumor staging, risk assessment and option of chemotherapy or radiotherapy to improve the patients' survival.
除腋窝淋巴结（ALN）外，内乳淋巴结（IMNs）是乳腺癌淋巴引流的主要途径。然而，由于缺乏可行且安全的活检方法，内乳淋巴结的处理在乳腺癌手术中仍存在争议。
2005年至2009年，共招募了337例连续的乳腺癌女性患者。所有患者均通过肋间间隙进行内乳淋巴结活检或内镜下淋巴链切除术。根据当前的美国临床肿瘤学会/美国病理学家协会（ASCO/CAP）指南重新检测雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER-2）状态。我们分析了临床病理参数与内乳淋巴结转移之间的关系，并研究了乳腺癌内乳淋巴结转移的高危因素和预后价值。
337例患者中，314例患者接受了肋间间隙内乳淋巴结活检，23例患者接受了内镜下淋巴链切除术。共有63例（18.69%）患者经病理诊断为内乳淋巴结转移。其中，28例（44.44%）患者改变了病理淋巴结分期，15例（23.81%）患者改变了术后综合治疗方案并接受了扩大的术后放疗。多因素分析显示，与无腋窝淋巴结受累相比，1-3枚腋窝淋巴结受累患者内乳淋巴结转移风险显著增加（OR = 42.097，95%CI = 5.225-339.178；P = 0.0004）以及≥4枚腋窝淋巴结受累患者（OR = 82.429，95%CI = 10.134-670.496；P < 0.0001）。HER-2阳性患者内乳淋巴结转移风险显著高于阴性患者（OR = 5.452，95%CI = 2.353-12.634；P < 0.0001）。然而，我们未发现内乳淋巴结受累是总生存和无病生存的独立指标。
我们的临床实践和数据表明，通过肋间间隙和内镜下淋巴链切除术进行内乳淋巴结活检是检测内乳淋巴结状态的有效且微创的方法，这可能有助于准确的肿瘤分期、风险评估以及化疗或放疗方案的选择，以提高患者的生存率。
