title: Clinical Significance of Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: Review of 264 Cases.
abstract: BACKGROUND
  Despite the knowledge of alternate lymphatic draining patterns of the breast, routine evaluation of the internal mammary lymph node basin is still not considered standard of care. The advent of microsurgical breast reconstruction using the internal mammary vessels as recipients, however, has allowed sampling of internal mammary lymph nodes with technical ease, thus revisiting their role in breast cancer management. In the present study, the authors reviewed their experience with this practice.
  
  
  METHODS
  A retrospective analysis of patients who underwent internal mammary lymph node biopsy at the time of autologous breast reconstruction using the internal mammary vessels between 2004 and 2012 was performed. Parameters of interest included patient age, timing of reconstruction (immediate versus delayed), disease stage, and pathologic findings of internal mammary lymph nodes.
  
  
  RESULTS
  A total of 264 autologous breast reconstructions using the internal mammary vessels were performed in 204 patients with a median age of 44.5 years. The majority of reconstructions were immediate [n = 211 (79.9 percent)]. Seventy-two percent of patients had either stage I [72 patients (35.3 percent)] or stage II disease [75 patients (36.8 percent)]. Six patients were found to have internal mammary lymph node metastasis. Stage migration and alteration in adjuvant therapy occurred in all patients.
  
  
  CONCLUSIONS
  Internal mammary lymph node sampling at the time of autologous breast reconstruction using the internal mammary system should become routine practice, as the morbidity associated with internal mammary lymph node harvest is low and the impact in cases of nodal involvement is quite substantial.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Wright
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Kraneburg
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Leo R
authors.initials: LR
authors.lastname: Otake
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Anthony
authors.initials: A
authors.lastname: Echo
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Tim
authors.initials: T
authors.lastname: Lee
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Buchanan
authors.affiliation: Stanford, Calif.|From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity