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Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: A Prospective Study
Benjamin D Schultz1, Darren Sultan1, Grace Ha1
1Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York.
Journal of Reconstructive Microsurgery
|March 16, 2022
Summary
Routine internal mammary lymph node (IMLN) biopsy during breast reconstruction is a convenient method for detecting nodal involvement. This sampling can lead to upstaging and altered treatment for breast cancer patients.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Management
Background:
- Accurate assessment of regional lymph node basins is crucial for breast cancer management.
- Internal mammary lymph node (IMLN) basin biopsy is not routinely performed, despite draining the medial breast pole.
- Positive IMLN biopsies often occur with negative axillary sentinel lymph nodes.
Purpose of the Study:
- To prospectively evaluate the utility of routine internal mammary lymph node (IMLN) biopsy during microsurgical breast reconstruction.
- To assess the oncological yield and clinical impact of IMLN sampling in this patient population.
Main Methods:
- Prospective study of 270 consecutive patients undergoing microsurgical breast reconstruction from July 2018 to June 2021.
- Data collected included reconstruction type, IMLN sampling, demographics, disease stage, and pathology.
- Internal mammary lymph node (IMLN) biopsies were performed concurrently with recipient vessel dissection.
Main Results:
- 5 out of 270 patients (1.9%) had positive internal mammary lymph node (IMLN) biopsies.
- One patient with a positive IMLN also had positive axillary sentinel lymph nodes.
- Two patients were upstaged due to positive IMLN findings, requiring chemoradiation.
Conclusions:
- Direct visualization of internal mammary lymph nodes (IMLNs) during microsurgical breast reconstruction allows for convenient sampling.
- IMLN biopsy offers minimal donor site morbidity and enhances therapeutic management for patients with nodal involvement.
- Routine internal mammary lymph node (IMLN) sampling is recommended for improved breast cancer management.
