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Implications of Internal Mammary Lymph Node Sampling During Microsurgical Breast Reconstruction
Jessica F Rose1, Dmitry Zavlin2, Zachery K Menn1
1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA.
Annals of Surgical Oncology
|July 28, 2018
Summary
Biopsying internal mammary lymph nodes (IMNs) during breast reconstruction is a simple procedure. Positive IMN findings can significantly alter cancer staging and treatment plans, improving patient care.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Internal mammary lymph node (IMN) chain assessment in breast cancer is debated.
- IMN metastasis impacts cancer staging, prognosis, treatment, and survival.
- Recent oncologic data highlight the significance of IMN chain evaluation.
Purpose of the Study:
- To analyze data from IMN sampling during breast reconstruction.
- To evaluate oncologic treatment changes based on IMN biopsy results.
Main Methods:
- Retrospective chart review of 581 patients undergoing free-flap breast reconstruction.
- Pathological examination of all dissected IMNs.
- Review of patient demographics, oncologic data, and IMN sampling outcomes.
Main Results:
- Nine out of 273 patients (3.3%) had positive IMNs.
- Positive IMNs led to increased cancer stage in seven patients.
- Six patients required treatment changes, including chemotherapy and radiation therapy.
Conclusions:
- Opportunistic IMN biopsy during microsurgical anastomosis is safe and adds no morbidity.
- Routine IMN biopsy is recommended for breast cancer patients undergoing internal mammary vessel dissection.
- Positive IMN findings warrant comprehensive oncological workup and treatment reassessment.
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