Eckert Kathryn M, Boughey Judy C, Piltin Mara A
Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Transl Breast Cancer Res. 2024 Apr 29;5:11. doi: 10.21037/tbcr-24-2. eCollection 2024.
While the axillary nodal basin is the most common lymphatic drainage pathway of the breast, the internal mammary (IM) lymph node chain plays a significant role in breast cancer staging and treatment. It has been identified as sentinel nodal drainage in approximately 13-37% of patients. Despite this, the data is still limited with regard to diagnosis and management when there is suspicion or confirmation of IM lymph node (IMLN) involvement by metastatic breast cancer. The objective of this publication is to provide a comprehensive assessment of the current body of literature surrounding the diagnosis, management and prognostic value of IMLNs in breast cancer treatment.
Review of the literature published regarding IMLN diagnosis, significance, and management was completed in PubMed. Additional focus was placed on reviewing articles published within the past 10 years as foundation for an update regarding the current practice and future directions in this space.
Improved imaging techniques, with positron emission tomography-computed tomography and magnetic resonance imaging, have led to increase in the identification of IM lymphadenopathy, yielding surgical staging of the IM nodes nearly obsolete. While IM nodal metastases may play a role in overall survival (OS), it has not been demonstrated to be an independent risk factor for increased locoregional recurrence. IM nodal irradiation (IMNI) therapy has been a mainstay in the treatment of IM disease in the context of breast cancer. IMNI has demonstrated improvement in OS and risk of distant recurrence. Wide variations in radiation practices for patients with IM lymphadenopathy exist internationally, highlighting the lack of clear data driven consensus guidelines.
Herein, we provide an updated assessment of the current diagnosis, clinical significance, and management of IM lymphadenopathy for breast cancer patients.
虽然腋窝淋巴结是乳腺最常见的淋巴引流途径，但内乳淋巴结链在乳腺癌分期和治疗中起着重要作用。在约13%-37%的患者中，它已被确定为前哨淋巴结引流部位。尽管如此，当怀疑或证实转移性乳腺癌累及内乳淋巴结（IMLN）时，关于其诊断和管理的数据仍然有限。本出版物的目的是全面评估围绕IMLN在乳腺癌治疗中的诊断、管理和预后价值的现有文献。
在PubMed上完成了关于IMLN诊断、意义和管理的文献综述。额外重点关注了过去10年内发表的文章，作为该领域当前实践和未来方向更新的基础。
正电子发射断层扫描-计算机断层扫描和磁共振成像等改进的成像技术，已导致内乳淋巴结病的识别增加，使得内乳淋巴结的手术分期几乎过时。虽然内乳淋巴结转移可能在总生存期（OS）中起作用，但尚未证明它是局部区域复发增加的独立危险因素。内乳淋巴结照射（IMNI）治疗一直是乳腺癌背景下内乳疾病治疗的主要手段。IMNI已证明可改善OS和远处复发风险。国际上针对内乳淋巴结病患者的放疗实践存在很大差异，突出表明缺乏明确的数据驱动的共识指南。
在此，我们对乳腺癌患者内乳淋巴结病的当前诊断、临床意义和管理提供了最新评估。
