Thoracoscopic internal mammary sentinel node biopsy for breast cancer

Sentinel node (SN) biopsy has changed the management of breast cancer. This pilot study assessed the utility of lymphatic mapping and thoracoscopic SN biopsy for internal mammary node (IMN) staging. Forty-nine breast cancer patients underwent lymphatic mapping using 99mTc-tin colloid. Patients with IMSNs underwent thoracoscopic biopsy. Lymphoscintigraphy showed IMSNs in 15 of 49 cases (31%). The incidence of IMN drainage was relationed to age and tumor location; 50% of patients younger than age 40 and 43% with tumors located in inner quadrants had IMN drainage. The thoracoscopic procedure was performed in 11 of 15 patients, and 18 IMSNs were removed; the time of the procedure ranged from 20 to 60 min. No patients had complications from the procedure. Two of 11 patients (18%) had IMSN metastasis, and one of them had only IMN metastasis. Lymphatic mapping and the thoracoscopic approach were useful for IMSN biopsy. They may enable the physician to make an appropriate treatment decision for breast cancer.