Breast lymphography revealed linkage between the axillary and parasternal lymph nodes in three out of 55 patients with breast cancer. In all the cases the efferent lymph vessels outlined laterally and, according to Berg's scheme, lymph node groups I, II and III were filled. Lymph vessel responsible for the filling of the parasternal lymph nodes branched from the area of group I lymph nodes. In two out of the 3 cases axillary metastasis was detected in one case, however, the axillary was found unaffected. The lymph vessel linkage observed doesn't seem to support the widely accepted concept, according to which there are only direct efferent lymph vessels running from the breast to the parasternal lymph nodes. This finding also explains why the incidence of parasternal metastases in the breast is higher in the case of tumorous obstruction of the axillary lymph nodes.
"The detection of IM nodes or other non-axillary sentinel nodes is largely dependent on the method of injection of isotope and the use of lymphoscintigraphy to detect involved nodes. A peri-tumoural injection technique visualises IM lymph nodes in about 15–30% of women, whereas subdermal or subareolar injection of isotope does not seem to identify IM nodes (Kett et al, 1993; Borgstein et al, 1997, 2000; Roumen et al, 1999; Cserni and Szekeres, 2001; Shen et al, 2001; Tanis et al, 2001). The mammary gland and the overlying skin clearly show a common lymphatic pathway to the axilla and the same axillary sentinel node in most cases (Dupont et al, 2001), but they do not appear to both drain to the IM chain. "
[Show abstract][Hide abstract] ABSTRACT: The long-term follow-up of patients treated with extended radical mastectomy has proved that the internal mammary node (IMN) status is an important prognosticator of breast cancer. Patients with isolated IMN involvement seem to have the same outcome as those with limited axillary disease, and these patients may therefore be overstaged in the TNM system. Sentinel node biopsy (SNB) of IMNs may be an ideal staging procedure, but lymphatic mapping studies demonstrate that data from extended radical mastectomy series cannot be extrapolated to patients suitable for SNB, where the IMN involvement is <5% overall, and around 1% for IMN metastases without axillary disease. Current evidence does not allow internal mammary SNB to be recommended as a standard procedure, but as patients with IMN involvement may benefit from adjuvant systemic treatment, internal mammary SNB should be further studied in this context.
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