title: Thoracoscopic approach of the internal thoracic lymphatic chain.
abstract: OBJECTIVE
  Few studies to date have evaluated the videothoracoscopic approach of the internal thoracic lymphatic chain. However, the histological evaluation of lymph nodes is essential for patients with breast cancer who show lymph node uptake at scintigraphy in the preoperative period and also for patients with lymphoma who have exclusive uptake in these lymph nodes at positron emission tomography for recurrence assessment. Our goal was to evaluate the safety and the change in oncologic approach through this minimally invasive technique.
  
  
  METHODS
  This is a review of the prospectively collected data in a group of patients undergoing thoracoscopic biopsy of the thoracic lymphatic chain in patients with breast cancer and lymphoma carried out in our institution between September 2010 and June 2012. The analyzed variables include age, histological type, operated hemithorax, number of resected lymph nodes, neoplastic involvement of the resected lymph nodes, duration of chest tube drainage, length of hospital stay, and perioperative mortality. Complications such as subcutaneous emphysema and necessity for blood transfusion were also evaluated.
  
  
  RESULTS
  Thoracoscopic biopsy was successfully performed in 16 patients, of whom 14 had breast cancer and 2 had lymphoma. The surgical biopsy results changed the treatment in the two patients with lymphoma and avoided radiotherapy in the eight patients with breast cancer who did not have metastases.
  
  
  CONCLUSIONS
  The use of the thoracoscopic assessment of the internal thoracic lymphatic chain seems safe and resulted in therapy modification in more than half of our patients, suggesting that it is an effective technique for staging in selected breast cancer and lymphoma cases.
authors.affiliation: Department of Thoracic Surgery, Hospital Santa Marcelina and Hospital Beneficiência, Portuguesa, Brazil. fernandocabrao@uol.com.br
authors.forename: Fernando Conrado
authors.initials: FC
authors.lastname: Abrão
authors.forename: Mauro Federico Luis
authors.initials: MF
authors.lastname: Tamagno
authors.forename: Igor Renato Louro Bruno
authors.initials: IR
authors.lastname: Abreu
authors.forename: Fernanda Sobreiro
authors.initials: FS
authors.lastname: Alfinito
authors.forename: Jose Roberto
authors.initials: JR
authors.lastname: Piato
authors.forename: Ligia Maria Teixeira Pereira
authors.initials: LM
authors.lastname: Silva
authors.forename: Ricardo Mingarini
authors.initials: RM
authors.lastname: Terra
authors.forename: Angelo
authors.initials: A
authors.lastname: Fernandez
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000473:pathology; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*