title: Surgical approach to internal mammary sentinel node biopsy.
abstract: BACKGROUND
  Internal mammary node (IMN) metastasis has a similar prognostic importance as axillary nodal involvement. However, sampling of IMN is not performed routinely.
  
  
  OBJECTIVE
  To evaluate a simplified method for internal mammary sentinel node (IMSN) biopsy of breast cancer patients.
  
  
  METHODS
  A combination of simultaneous perilesional and intradermal radiocolloid injections over the lesion was used. All IMSNs were confirmed by lymphoscintigraphy and Carbon Nanoparticles Suspension Injection preoperatively and excised extrapleurally through the intercostal muscles.
  
  
  RESULTS
  Twenty-three of the 94 patients were found to have metastatic disease in the IMSNs. Four of 65 patients had metastases in the IMNs but not in the axilla. All 23 patients with positive IMSN were upstaged and received radiation to the internal mammary chain. The time from separating the pectoral major muscle to touch the node was ranged 21-48 min. The detecting sensitivity combined with preoperative lymphoscintigraphy, intraoperative gamma probe detection, and intraoperative black dye methods for IMSN was 100%.
  
  
  CONCLUSIONS
  The approach used is a reliable surgical technique for removing IMSN. It can improve the nodal staging in breast cancer with IMN metastases.
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital, Jinan 250031, P.R. China. paolo.cotogni@unito.it
authors.forename: Qingqing
authors.initials: Q
authors.lastname: He
authors.forename: Dayong
authors.initials: D
authors.lastname: Zhuang
authors.forename: Jun
authors.initials: J
authors.lastname: Tian
authors.forename: Luming
authors.initials: L
authors.lastname: Zheng
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Fan
authors.forename: Xueliang
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D042361:Mammary Glands, Human / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*