title: Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients.
abstract: BACKGROUND
  The aim of this study was to determine the visualization rate, identification rate, and clinical implications of biopsy of sentinel nodes in the internal mammary chain (IMC) in patients with breast cancer.
  
  
  METHODS
  From January 1999 to December 2002, 691 sentinel node procedures were performed. Preoperative lymphoscintigraphy was performed after injection of (99m)Tc-labeled nanocolloid into the tumor (.2 mL; 115 MBq; 3.1 mCi). The sentinel node was surgically identified with the aid of patent blue dye and a gamma ray detection probe.
  
  
  RESULTS
  The sentinel node in the IMC could be harvested in 130 (87%) of the 150 patients in whom it was visualized on the images and contained metastases in 22 (17%) of these 130 cases. In nine patients (7%), the IMC sentinel node was tumor positive, whereas the axilla was tumor-free. Stage migration was seen in all patients with a tumor-positive IMC sentinel node (17%). There was a change of management in 38 (29%) of the 130 patients: institution or omission of radiotherapy to the IMC, adjuvant systemic therapy, or omission of an axillary lymph node dissection.
  
  
  CONCLUSIONS
  Pursuit of IMC sentinel nodes improves the staging of patients with breast cancer and enables treatment to be better adjusted to the needs of the individual patient.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. s.estourgie@nki.nl
authors.forename: Susanne H
authors.initials: SH
authors.lastname: Estourgie
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: Emiel J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: Bin B R
authors.initials: BB
authors.lastname: Kroon
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid