Parasternal Metastasis Research Articles

"Sentinel" lymph node biopsy in breast carcinoma. Current experiences

Recent studies show the sentinel lymph node biopsy (SNB) as a reliable method for the determination of the nodal status in patients with breast cancer. We present our experience with this method during 3 years and discuss its potential and limitations. From 11/95 to 3/99 we performed a sentinel node detection in 146 patients with breast cancer stage I to III. We used the raionuclide method including preoperative lymphscintigraphy and intraoperative gamma.probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter < 1 cm, 85% (1-3 cm), 70% (3-5 cm) and 63% (> 5 cm). The accuracy of the SNB in the prediction of the nodal status varied also with the tumor diameter between 100% for very small tumors (< 1 cm), 97% (1-3 cm), 88% (3-5 cm) and 67% (> 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53%) showed true negative, 4 (4%) false negative SNB. 38 (36%) revealed tumor cells in the HE-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. The presented results show, that SNB is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3 cm. While in about 50% of these patients a surgical intervention could be avoided after a negative SNB, an additional 5-10% of conventionally nodal negative patients can be found by the immunohistochemical examination of the sentinel node. The sn-concept can also identify parasternal metastasis and can be applied in patients after neoadjuvant therapy and patients with recurrent tumor. Indications and contraindications of this method, however, still remain to be determined.

The value of parasternal lymphoscintigraphy with microcolloids in the staging and follow-up of breast carcinoma

Over a period of twelve years we have performed 793 parasternal lymphoscintigrams with microcolloids in 272 patients with unilateral carcinoma of the breast. In 173 patients we were able to follow their course with an average of four examinations and an average period of observation of 48 months. The parasternal lymph nodes could be identified in 59.6% (on the side of the tumour in 55.1%, on the contralateral side in 64.2%). Expressed as an index with maximal value of 1, the (non-)demonstration constant was 0.79 (side of the tumour 0.78, opposite side 0.80). Comparison of the total scans with the initial findings showed general loss of scintigraphic uptake which, however, is not reflected during individual ICR localisation. Patients with the highest prevalence of parasternal metastases showed atypical uptake. There was no change in uptake in those patients who subsequently developed distant metastases.

Current methods of diagnosis and therapy of carcinoma of the breast

Although prognosis of carcinoma of the breast in clinical stages I and II is conditioned by many factors, early diagnosis and prompt treatment are at present the most useful means at our disposal to achieve the best results. Early diagnosis, and better still the detection of tumours in a preclinical stage, can be arrived at by breast self-examination, periodic check-up and mammography. The latter is particularly useful in revealing clinically silent lesions. Only excisional biopsy can ascertain the diagnosis which it is important to establish when the intramammary lump, because of its small size, lacks any sign of malignancy. Recent studies of the lymphatic spread of breast carcinoma have demonstrated that the parasternal metastases are not a late manifestation of the disease but rather a frequent finding in cancer in clinical stages I and II. These metastases are correlated, not only to the site of the tumor in the inner quadrants of the mammary gland, but also to the metastatic index of the axillary lymph nodes. A similar correlation exists between the number of axillary nodes involved and the frequency of microscopic supraclavicular metastases. When radical surgery is indicated, it should comprise the excision of the internal mammary lymph nodes, and in case a supraclavicular dissection. Inoperable cases should be treated by radiotherapy and chemotherapy. Recently pre, intra and postoperative chemotherapy is being increasingly carried out in association with the basic radio-surgical therapy, but such treatment can only be of help as an adjuvant of radical surgery, not as a substitute for an incomplete operation.