title: Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients.
abstract: BACKGROUND
  Involvement of the internal mammary chain lymph nodes (IMNs) is associated with worsened prognosis in breast cancer. Use of lymphoscintigraphy to visualize sentinel nodes reveals that IMNs often receive lymph from the area containing the tumor.
  
  
  METHODS
  We biopsied IMNs in 182 patients because there was radiouptake to the IMNs or because the tumor was located in the medial portion of the breast. After tumor removal, pectoralis major fibers were divided to expose intercostal muscle. A portion of intercostal muscle adjacent to the sternum was removed. Lymph nodes and surrounding fatty tissue in the intercostal space were freed, removed, and analyzed histologically. The pleural cavity was breached in four cases (2.2%), with spontaneous resolution.
  
  
  RESULTS
  IMNs were found in 160 (88%) of 182 patients; 146 (94.4%) were negative and 14 (8.8%) were positive. The latter received internal mammary chain radiotherapy. The axilla was negative in 4 of 14 cases and positive in 10.
  
  
  CONCLUSIONS
  IMNs can be quickly and easily removed via the breast incision with insignificant risk and no increase in postoperative hospitalization. The patients with a positive IMN migrated from N0 (4 cases) or N1 (10 cases) to N3, prompting modification of both local (radiotherapy to internal mammary chain) and systemic treatment; without IMN sampling, they would have been understaged.
authors.affiliation: Divisions of Senology, European Institute of Oncology, Milan, Italy. viviana.galimberti@ieo.it
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.forename: Paolo
authors.initials: P
authors.lastname: Arnone
authors.forename: Concetta
authors.initials: C
authors.lastname: De Cicco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Mattia
authors.initials: M
authors.lastname: Intra
authors.forename: Stefano
authors.initials: S
authors.lastname: Zurrida
authors.forename: Virgilio
authors.initials: V
authors.lastname: Sacchini
authors.forename: Roberto
authors.initials: R
authors.lastname: Gennari
authors.forename: Annarita
authors.initials: A
authors.lastname: Vento
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy