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Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for
Rashmi K Benda1, Juan C Cendan, Edward M Copeland
1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA. bendark@shands.ufl.edu
Cancer
|January 28, 2004
Summary
Sentinel lymph node biopsy can identify internal mammary lymph node (IMN) involvement, but current lymphoscintigraphy (LS) techniques show low IMN flow rates. Clinical factors remain crucial for treatment decisions when IMN involvement is suspected.
Area of Science:
- Oncology
- Nuclear Medicine
- Surgical Oncology
Background:
- Internal mammary lymph node (IMN) metastases treatment is controversial due to prediction difficulties, morbidity, and efficacy concerns.
- Sentinel lymph node biopsy (SLNB) aids in identifying occult IMN involvement for patient selection.
- Lymphoscintigraphy (LS) is a key imaging modality for detecting IMN drainage.
Purpose of the Study:
- To evaluate the predictive value of tumor characteristics for IMN drainage.
- To assess the association between IMN drainage and IMN radiotherapy.
- To determine the incidence of IMN involvement using LS.
Main Methods:
- Retrospective review of 262 lymphoscintigraphies (LS) from 248 patients (1998-2002).
- Assessment of tumor characteristics (location, size, lymphovascular invasion, nodal status, laterality) for predicting IMN drainage.
- Comparison of IMN radiotherapy use based on tumor characteristics and nodal status.
Main Results:
- Lymph flow to IMN was detected in 9% of cases.
- No correlation found between IMN flow and tumor location, size, lymphovascular invasion, nodal status, or breast laterality.
- Deep injection technique increased IMN flow identification from 5.7% to 10.1%.
- IMN radiotherapy was more frequent in larger tumors (T2-T4) and node-positive patients.
- Medial tumors in T2N0 patients showed higher IMN radiotherapy rates (45%) compared to lateral tumors (19%).
Conclusions:
- The incidence of IMN flow detected by current LS is lower than reported in older series.
- Histopathologic information for sentinel IMN is obtained when flow is identified.
- Clinical factors remain essential for treatment decisions in the absence of definitive IMN histopathologic data.