Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA.
Department of Plastic Surgery, Rambam Hospital, Haifa, Israel.
Ann Surg Oncol. 2018 Oct;25(11):3134-3140. doi: 10.1245/s10434-018-6679-z. Epub 2018 Jul 26.
Internal mammary lymph node (IMN) chain assessment for breast cancer is controversial; however, current oncologic data have shed new light on its importance. Metastatic involvement of the IMN chain has implications for staging, prognosis, treatment, and survival. Here, we analyzed our data gathered during sampling of the IMN and the oncologic treatment changes that resulted from our findings.
A retrospective chart review was performed on 581 patients who underwent free-flap breast reconstruction performed by the senior author. All dissected IMNs were submitted for pathological examination. Patient demographics, oncologic data, and the results of IMN sampling were reviewed.
581 patients undergoing 981 free flaps were identified. A total of 400 lymph node basins were harvested from 273 patients. Of these, nine had positive IMNs. Two of these nine patients had positive IMNs of the contralateral nonaffected breast. Five patients had positive axillary lymph nodes. Four patients had multifocal tumors, one of which was bilateral. Seven patients had an increase in cancer stage as a result of having positive IMNs. Six patients had a change in treatment: two patients required additional chemotherapy, one received adjuvant radiation therapy, and three necessitated both supplemental chemotherapy and radiation.
Opportunistic biopsy of the IMN while dissecting the recipient vessels is simple and results in no added morbidity. We recommend that biopsy of the IMN chain be performed whenever internal mammary vessels are dissected for microsurgical anastomosis in breast cancer patients. Positive IMN involvement should encourage thorough oncological workup and treatment reevaluation.
Case series.
乳腺癌的内乳淋巴结（IMN）链评估存在争议；然而，目前的肿瘤学数据为其重要性提供了新的视角。IMN 链的转移性累及对分期、预后、治疗和生存都有影响。在这里，我们分析了在对 IMN 进行取样期间收集的数据，以及由此发现导致的肿瘤学治疗变化。
对由资深作者进行的 581 例游离皮瓣乳房重建患者进行了回顾性图表审查。所有解剖的 IMN 均进行了病理检查。回顾了患者的人口统计学数据、肿瘤学数据以及 IMN 取样结果。
确定了 581 例接受 981 个游离皮瓣的患者。从 273 例患者中共采集了 400 个淋巴结区。其中 9 例 IMN 阳性。这 9 例患者中有 2 例对侧非受累乳房的 IMN 阳性。5 例患者腋窝淋巴结阳性。4 例患者有多个肿瘤，其中 1 例为双侧。7 例患者由于 IMN 阳性而癌症分期增加。6 例患者的治疗发生变化：2 例需要额外的化疗，1 例接受辅助放疗，3 例需要补充化疗和放疗。
在解剖受区血管时对内乳淋巴结进行机会性活检既简单又不会增加发病率。我们建议，在乳腺癌患者进行内乳血管显微吻合时，应进行 IMN 链活检。IMN 阳性受累应鼓励进行彻底的肿瘤学检查和治疗再评估。
证据等级 IV：病例系列。
