Surgical approach to internal mammary lymph node biopsy.

Abstract

In the management of breast cancer, lymphatic mapping and sentinel lymph node (SLN) biopsy has emerged as an acceptable standard of care for assessing the status of the axilla in selected patients. In studies of SLN biopsy coupled with preoperative lymphoscintigraphy, several authors have reported extraaxillary drainage of tracer, particularly to the internal mammary (IM) chain. Proposed changes to the American Joint Committee on Cancer staging manual will place added emphasis on the status of the IM nodes (IMNs) in the staging of breast cancer. These changes, based on the work of Veronesi and others, demonstrate that a positive IMN has the same influence on prognosis as a positive axillary node, and that when both are positive, the influence on outcomes is additive. These facts suggest that surgeons can likely be faced with removing IMNs, a procedure that has been extremely uncommon in the majority of general surgical practices in recent times. Here we report our technique for biopsy of the IMSLN. This technique was performed in a subset of 142 consecutive patients in whom IM-SLNs were visible on lymphoscintigraphy. In this experience, we noted no increase in morbidity beyond that associated with standard breast cancer procedures.