title: Detecting of breast cancer metastasis by means of regional lymph node sampling during autologous breast reconstruction--a screening of 519 consecutive patients.
abstract: BACKGROUND
  The internal mammary artery and vein is often used as a site of anastomoses in microvascular breast reconstruction. This area supports lymphatic drainage of the breast and its role in breast cancer metastasis remains unclear. We hypothesize that sampling of internal mammary lymph nodes at the time of microvascular anastomoses preparation may identify persistent or recurrent local disease and mandate the need for additional treatment in this area.
  
  
  METHODS
  A retrospective chart review from 519 patients in the time between January 2006 and September 2009 was performed on all patients who underwent internal mammary lymph node sampling at the time of microvascular breast reconstruction.
  
  
  RESULTS
  Microvascular breast reconstruction was performed in 519 patients. Enlarged internal mammary lymph nodes were found and harvested in 195 patients for histological review. Six of 195 (3.08%) were found positive for metastatic disease requiring additional oncologic treatment.
  
  
  CONCLUSIONS
  The internal mammary lymphatic drainage system is an important and often underappreciated pathway for breast metastasis. Routine sampling of these lymph nodes at the time of microvascular breast reconstruction is easy to perform and is a useful tool to identify women, who might require additional treatment and increase cancer-free survival.
authors.affiliation: Department of Plastic and Aesthetic Surgery, Interdisciplinary Breast Centre, Sana-Kliniken Düsseldorf, Gerresheim Hospital, Düsseldorf, Germany. christoph.andree@sana.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Andree
authors.forename: Volker J
authors.initials: VJ
authors.lastname: Schmidt
authors.forename: Beatrix I J
authors.initials: BI
authors.lastname: Munder
authors.forename: Katrin
authors.initials: K
authors.lastname: Seidenstücker
authors.forename: Philipp
authors.initials: P
authors.lastname: Behrendt
authors.forename: Christian
authors.initials: C
authors.lastname: Witzel
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.forename: Philipp
authors.initials: P
authors.lastname: Richrath
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D016462:Mammaplasty; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D021701:Sentinel Lymph Node Biopsy; D014182:Transplantation, Autologous; D055815:Young Adult