A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer.
OBJECTIVE
To evaluate the feasibility of internal mammary lymphatic chain dissection by thoracoscopic surgery.


METHODS
Thirty-two breast cancer women were involved in this pilot study, who were with lesion located at central area or internal quadrant, or with cN2 or cN3 ALNs, or with T4 tumor, or indicating IMNs drainage by preoperative lymphoscintigraphy, but without distant metastasis. Subareolar injection and peritumoral injection of 5 ml methylene blue were done before operation. Double cavity intubation was used to permit collapse of the homolateral lung and set-up the endoscopic operation space. Trocars were introduced through three thoracic incisions of less than 15 mm at the third, the fifth and the seventh intercostal spaces along the midaxillary line. Dissection of internal mammary lymphatic chain was performed by a thoracoscopic grasper and ultrasonically activated scalpel.


RESULTS
Thoracoscopic internal mammary lymphatic chain dissection was successfully finished in 28 patients. The procedure time was 30-70 min (45.2+/-9.6 min). A total of 128 internal mammary nodes were removed. Among the 28 patients, 11 had internal mammary node metastasis. Only one patient had internal mammary node metastasis without axillary node metastasis. All internal mammary nodes were located at the first rib to the fourth intercostal space. Thoracoscopic internal mammary lymphatic chain dissection in four patients was impossible because of unfavorable local anatomic conditions. There was no damage on great vessels or the lungs, nor pulmonary atelectasis or pulmonary infection.


CONCLUSIONS
Thoracoscopic internal mammary lymphatic chain dissection is feasible, and it is easy to perform without serious additional complications. It may improve nodal staging of breast cancer with internal mammary node.
Southwest Hospital, Department of Breast Centre, GaoTanYan 29, Shapingba District, Chong Qing 400038, China.
Qingqing
Q
He
Jun
J
Jiang
Xinhua
X
Yang
Linjun
L
Fan
Meiqin
M
Guo
Yi
Y
Zhang
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010865:Pilot Projects; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome