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Internal Mammary Nodal Chain Drainage Is a Prognostic Indicator in Axillary Node-Positive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Internal mammary (IM) nodes are a potential site of breast lymphatic drainage. We examined the relationship between lymphoscintigraphic evidence of IM drainage and survival in early-stage breast cancer patients (pts).

Methods

From a prospective database of 855 consecutive sentinel node mapping procedures using peritumoral radiocolloid injection from 1996–2004, we analyzed the 604 cases with stage I–III breast cancer. Overall survival and recurrence-free survival (OS, RFS) rates were compared in pts with (IM+) and without (IM-) IM drainage on lymphoscintigraphy using Kaplan-Meier plots and Cox proportional hazards models. Results: 100 of 604 pts (17%) showed IM drainage. Five-year OS and RFS were 92% vs 88% and 88% vs 85% in IM- vs IM+ pts. In the 186 pts with axillary metastases (node+), 5-year OS and RFS were 91% vs 71% and 84% vs 69% in IM- vs IM+ pts. Univariate analysis of node+ pts estimated increased mortality risk for IM+ (hazard ratio, HR 2.9, P = .04), ≥4 positive nodes (HR 3.2, P = .02), tumors that were ER-negative (HR 3.4, P = .02), or had high Ki-67 (HR 6.8, P = .01). Multivariate analysis estimated similar increased risks [≥4 nodes (HR 4.0, P = .02), IM+ (HR 3.3, P = .06), and ER negativity (HR 2.6, P = .09)].

Conclusions

IM nodal drainage predicted a nearly 3-fold increased mortality risk in node+ pts. Peritumoral radiocolloid injection provides a clinically relevant assessment of IM drainage and should be prospectively tested for its value in tailoring treatment strategies for axillary node-positive pts.

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ACKNOWLEDGMENT

NIH Grants CA90771 and CA72064 supported this work. The authors wish to thank the physicians and staff, particularly the nuclear medicine technologists, at the University of Washington Medical Center, Division of Nuclear Medicine and Department of Surgery, for their collaborations and care in the clinical mapping procedures for breast cancer patients.

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Authors and Affiliations

  1. Departments of Radiation Oncology, University of Washington Medical School, Seattle, WA, USA

    Michelle S. Yao

  2. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Brenda F. Kurland

  3. Internal Medicine, University of Washington Medical School, Seattle, WA, USA

    Anne H. Smith & David A. Mankoff MD, PhD

  4. Nuclear Medicine, University of Washington Medical School, Seattle, WA, USA

    Erin K. Schubert, Lisa K. Dunnwald & David A. Mankoff MD, PhD

  5. Surgery, University of Washington Medical School, Seattle, WA, USA

    David R. Byrd

Authors
  1. Michelle S. Yao
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  2. Brenda F. Kurland
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  3. Anne H. Smith
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  4. Erin K. Schubert
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  5. Lisa K. Dunnwald
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  6. David R. Byrd
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  7. David A. Mankoff MD, PhD
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Corresponding author

Correspondence to David A. Mankoff MD, PhD.

Additional information

Presented at the 29th Annual San Antonio Breast Cancer Symposium, December 14–17, 2006.

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Yao, M.S., Kurland, B.F., Smith, A.H. et al. Internal Mammary Nodal Chain Drainage Is a Prognostic Indicator in Axillary Node-Positive Breast Cancer. Ann Surg Oncol 14, 2985–2993 (2007). https://doi.org/10.1245/s10434-007-9473-x

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  • DOI: https://doi.org/10.1245/s10434-007-9473-x

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