[Lymph drainage from the breast to the parasternal lymph nodes].
Baranya megyei Kórház Sebészeti Osztály, Pécsi Orvostudományi Egyetem, Tanszék. Orvosi Hetilap
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.
Available from: PubMed Central
- "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. "
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ABSTRACT: Axillary lymph node involvement is the best prognostic factor for breast cancer survival. Staging breast cancers by axillary dissection remains standard management and is part of the UK national guidelines for breast cancer treatment. In the presence of involved axillary lymph nodes best treatment has been shown to be axillary clearance (Fentiman and Mansell, 1991), but clearly for women whose nodes are uninvolved avoidance of morbidity is optimal and this will be achieved by minimal dissection of the axilla. Thus, for node-negative women the introduction of the sentinel node biopsy technique may revolutionise the approach to the axilla. These will be women with mammographic screen detected small well and moderately differentiated tumours (Hadjiloucas and Bundred, 2000). The impact of sentinel node biopsy in women who have symptomatic large tumours is unproven, and around half of these women will require a second procedure to clear their axilla or radiotherapy as treatment. Even for those women found to have involved sentinel lymph nodes the ability to use early systemic chemotherapy followed by axillary clearance or radiotherapy may provide long-term survival gains. Sentinel node biopsy should not, however, become routine practice until randomised controlled trials have proven its benefit and safety in reducing morbidity. Several randomised controlled trials (including ALMANAC) are currently underway.
British Journal of Cancer (2002) 87, 691–693. doi:10.1038/sj.bjc.6600557 www.bjcancer.com
© 2002 Cancer Research UK
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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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