Faculty Collaboration Database

Impact of internal mammary lymph node drainage identified by preoperative lymphoscintigraphy on outcomes in patients with stage I to III breast cancer. Cancer 2012 Dec 15;118(24):6287-96

Date

06/01/2012

Pubmed ID

22648744

Pubmed Central ID

PMC3913471

DOI

10.1002/cncr.27564

Scopus ID

2-s2.0-84870656742 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

BACKGROUND: Involvement of internal mammary (IM) lymph nodes is associated with a poor prognosis for patients with breast cancer. This study examined the effect of drainage to IM nodes identified by lymphoscintigraphy on oncologic outcomes.

METHODS: A prospectively maintained breast cancer patient database at the University of Texas MD Anderson Cancer Center was used to identify patients with stage I to III breast cancer who underwent preoperative lymphoscintigraphy with peritumoral injection of colloid and intraoperative lymphatic mapping from 1996 to 2005. Medical records were reviewed of 1772 patients who had drainage to any lymph node basin on lymphoscintigraphy but who did not undergo IM nodal biopsy. Patients with IM drainage, with or without axillary drainage, were compared with patients without IM drainage. Local-regional recurrence, distant disease-free survival (DDFS), and overall survival were evaluated.

RESULTS: We identified IM drainage in 334 patients (18.8%). Patients with IM drainage were significantly younger, less likely to have upper outer quadrant tumors, and more likely to have smaller and medial tumors than patients without IM drainage. Rates of IM irradiation did not differ between the 2 groups. The median follow-up time was 7.4 years. On multivariate analysis, IM drainage was significantly associated with a worse DDFS (hazard ratio, 1.6; 95% confidence interval, 1.03-2.6; P = .04) but not local-regional recurrence or overall survival.

CONCLUSIONS: IM drainage on preoperative lymphoscintigraphy was found to be significantly associated with worse DDFS. Further study is needed to determine the role of lymphoscintigraphy in the personalization of breast cancer staging and therapy.

Author List

Kong AL, Tereffe W, Hunt KK, Yi M, Kang T, Weatherspoon K, Mittendorf EA, Bedrosian I, Hwang RF, Babiera GV, Buchholz TA, Meric-Bernstam F

Author

Amanda L. Kong MS, MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Axilla
Breast Neoplasms
Carcinoma, Ductal, Breast
Carcinoma, Lobular
Drainage
Female
Follow-Up Studies
Humans
Lymph Nodes
Lymphatic Metastasis
Lymphoscintigraphy
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Preoperative Care
Prognosis
Prospective Studies
Retrospective Studies
Sentinel Lymph Node Biopsy
Survival Rate
Technetium Tc 99m Sulfur Colloid
Young Adult