title: The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series.
abstract: The 'regional nodal mapping', is a fundamental step to stage breast carcinoma. In addition to the axillary nodes status, the involvement of internal mammary nodes is an important prognostic factor. Six hundred and sixty-three patients with breast carcinoma, mainly in the inner quadrants, underwent a biopsy of internal mammary nodes. Positive internal mammary nodes were found in 68 out of 663 cases (10.3%) representing 27.2% of all cases with regional node metastases (250). When histologically proven metastases were detected, radiotherapy was administered to the internal mammary nodes chain. In 254 cases, the surgeon's exploration was guided by a gamma probe. Out of these cases, 28 (11.0%) showed metastatic involvement. Out of the other 409 cases, not radioguided, 40 showed positive nodes (9.8%). Patients with internal mammary metastases treated with radiotherapy and appropriate systemic treatment showed an excellent survival (95% at 5 years), a result which is in opposition to the previous experience, which stated that invasion of internal mammary nodes is an ominous prognostic sign. We assume that this excellent result is due to radiotherapy to internal mammary nodes and we propose that exploration of internal mammary nodes should be part of the staging process of carcinomas of the medial part of the breast.
authors.affiliation: European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.it
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
authors.forename: P
authors.initials: P
authors.lastname: Arnone
authors.forename: P
authors.initials: P
authors.lastname: Veronesi
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: E
authors.initials: E
authors.lastname: Botteri
authors.forename: G B
authors.initials: GB
authors.lastname: Ivaldi
authors.forename: M C
authors.initials: MC
authors.lastname: Leonardi
authors.forename: G
authors.initials: G
authors.lastname: Viale
authors.forename: A
authors.initials: A
authors.lastname: Sagona
authors.forename: G
authors.initials: G
authors.lastname: Paganelli
authors.forename: R
authors.initials: R
authors.lastname: Panzeri
authors.forename: R
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008323:Mammary Arteries; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome