Internal mammary sentinel lymph node biopsy: abandon or persist?

Area of Science:

• Surgical Oncology
• Breast Cancer Research
• Nuclear Medicine

Background:

• Internal mammary lymph node (IMLN) metastases are often associated with axillary lymph node (ALN) involvement.
• Traditional internal mammary sentinel lymph node biopsy (IM-SLNB) techniques have low visualization rates, limiting clinical adoption.
• Previous trials often excluded patients with clinically positive ALN, failing to assess IMLN status in those most likely to benefit.

Purpose of the Study:

• To introduce and validate a modified injection technique for improved IM-SLNB visualization.
• To assess the feasibility of routine IM-SLNB in daily surgical practice.
• To evaluate the potential of IM-SLNB for personalized staging, prognosis, and treatment decisions in breast cancer patients.

Main Methods:

• A modified injection technique involving periareolar intraparenchymal injection, high volume, and ultrasonographic guidance.
• Application of IM-SLNB in a clinical setting to assess visualization rates.
• Analysis of IM-SLNB utility for staging and treatment planning, particularly in patients with clinically positive ALN.

Main Results:

• The modified technique significantly enhanced the visualization rate of internal mammary sentinel lymph nodes.
• Routine IM-SLNB is now feasible in daily practice due to improved visualization.
• IM-SLNB offers potential for individual minimally invasive staging and prognosis, especially for patients with clinically positive ALN.

Conclusions:

• The modified injection technique makes routine IM-SLNB practical, improving breast cancer staging.
• IM-SLNB facilitates personalized treatment decisions and tailored internal mammary lymph node radiotherapy.
• Clinicians should consider the role of regional IMLN therapy in the context of evolving adjuvant systemic therapies.