Skip to main content
SpringerLink
Log in

Internal mammary node status: A major prognosticator in axillary node-negative breast cancer

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: The internal mammary lymph nodes (IMN) have received little attention in recent years, yet are a well-documented site of metastasis and a major prognostic factor in early-stage breast cancer.

Methods/Results: Ten-year follow-up of the final 195 patients treated by extended radical mastectomy (ERM) in this practice (selected largely on the basis of medial tumor location, and comprising 15% of all patients treated from 1965 to 1978) found IMN + in 24% of all cases: 36% of AX + versus 18% of AX -patients (p=0.0023). In a multivariate analysis, the disease-free survival impact of IMN + (p=0.004) was second only to axillary node involvement (p<0.0005), and surpassed tumor size (p=0.077). IMN + was equally frequent for tumors less than, or greater than, 2 cm (24%), and was not significantly related to patient age. Among AX - patients, there was a twofold greater risk of recurrence or death at 10 years for IMN + than for IMN -. Among T1N0 patients, 19.6% were IMN +.

Conclusions: Failure to consider IMN status in the steadily enlarging cohort of T1N0 breast cancers may result in the undertreatment of a significant proportion of stage I patients. Systemic adjuvant therapy should be considered for T1N0 patients with central or medial tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cody HS, Laughlin EH, Trillo C, Urban JA. Have changing treatment patterns affected outcome for operable breast cancer? Ten-year follow-up in 1288 patients, 1965 to 1978.Ann Surg 1991;213:297–307.

    PubMed  Google Scholar 

  2. Urban JA. Radical mastectomy in continuity with en bloc resection of internal mammary lymph node chain; new procedure for primary operable cancer of breast.Cancer 1952;5:992.

    CAS  PubMed  Google Scholar 

  3. Breast. In: Beahrs OH, Myers MH, eds.Manual for staging of cancer, 2nd edition. Philadelphia: JB Lippincott, 1983:127–33.

    Google Scholar 

  4. Dixon WJ, ed.BMDP statistical software manual, vols I–II. Berkeley: University of California Press, 1988.

    Google Scholar 

  5. Handley RS, Thackray AC. Invasion of the internal mammary lymph glands in carcinoma of the breast.Br J Cancer 1947;1:15–20.

    Google Scholar 

  6. Handley RS. Carcinoma of the breast (the Bradshaw Lecture).Ann Royal Coll Surg Eng 1975;57:59–66.

    CAS  Google Scholar 

  7. Lacour J, Bucalossi P, Caceres E, et al. Radical mastectomy versus radical mastectomy plus internal mammary dissection: five-year results of an international cooperative study.Cancer 1967;37:206–14.

    Google Scholar 

  8. Veronesi U, Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery.Cancer 1981;47:170–5.

    CAS  PubMed  Google Scholar 

  9. Donegan WL. The influence of untreated internal mammary metastasis upon the course of mammary cancer.Cancer 1977;39:533–8.

    CAS  PubMed  Google Scholar 

  10. Host H, Brennhovd IO. The effect of postoperative radiotherapy in breast cancer.Int J Radiat Oncol Biol Phys 1977;2:1061–7.

    CAS  PubMed  Google Scholar 

  11. Wallgren A. A controlled study: pre-operative versus postoperative irradiation.Int J Radiat Oncol Biol Phys 1977;2:1167–9.

    CAS  PubMed  Google Scholar 

  12. Cuzick J, Steart H, Peto R, et al. Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer.Cancer Treat Rep 1987;71:15–29.

    CAS  PubMed  Google Scholar 

  13. Lacour J, Le M, Caceres E, et al. Radical mastectomy versus radical mastectomy plus internal mammary dissection: ten year results of an international cooperative trial in breast cancer.Cancer 1983;51:1941–3.

    CAS  PubMed  Google Scholar 

  14. Lacour J, Le MG, Hill C, et al. Is it useful to remove internal mammary nodes in operable breast cancer?Eur J Surg Oncol 1987;13:309–14.

    CAS  PubMed  Google Scholar 

  15. Meier P, Ferguson DJ, Karrison T. A controlled trial of extended radical versus radical mastectomy: ten-year results.Cancer 1989;63:188–95.

    CAS  PubMed  Google Scholar 

  16. Li KYY, Shen Z-Z. An analysis of 1242 cases of extended radical mastectomy.Breast 1984;10:10–9.

    Google Scholar 

  17. Deemarski LY, Seleznev IK. Extended radical operations on breast cancer of medial or central location.Surgery 1984;96:73–7.

    PubMed  Google Scholar 

  18. Urban JA. Management of operable breast cancer: the surgeon's view.Cancer 1978;42:2066–77.

    CAS  PubMed  Google Scholar 

  19. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma.J Clin Oncol 1991;9:988–96.

    CAS  PubMed  Google Scholar 

  20. Haagensen CD. Anatomy of the mammary glands. In: Haagensen CD, ed.Diseases of the breast, 3rd ed. Philadelphia: WB Saunders, 1986.

    Google Scholar 

  21. Veronesi U, Cascinelli N, Greco M, et al. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes.Ann Surg 1985;202:702–7.

    CAS  PubMed  Google Scholar 

  22. Morrow M, Foster RS. Staging of breast cancer: a new rationale for internal mammary node biopsy.Arch Surg 1981;116:748–51.

    CAS  PubMed  Google Scholar 

  23. Veronesi U, Cascinelli N, Bufalino R, et al. Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients.Ann Surg 1983;198:681–4.

    CAS  PubMed  Google Scholar 

  24. Turner-Warwick RT. The lymphatics of the breast.Br J Surg 1959;46:574–82.

    CAS  PubMed  Google Scholar 

  25. Osborne MP, Jeyasingh K, Jewkes RF, Burn I.Br J Surg 1979;66:813–8.

    CAS  PubMed  Google Scholar 

  26. Urban JA, Marjani MA. Significance of internal mammary lymph node metastases in breast cancer.Am J Roentgenol Radiother Nucl Med 1971;3:130–6.

    Google Scholar 

  27. Handley RS. Cancer of the breast.Am Surg 1975;41:667.

    CAS  PubMed  Google Scholar 

  28. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24740 breast cancer cases.Cancer 1989;63:181–7.

    CAS  PubMed  Google Scholar 

  29. Rosen PP, Groshen S, Saigo P, et al. A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma.J Clin Oncol 1989;7:355–66.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Department of Surgery, The New York Hospital-Cornell Medical Center, and the Breast Service, USA

    Hiram S. Cody III MD & Jerome A. Urban MD

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Hiram S. Cody III MD & Jerome A. Urban MD

Authors
  1. Hiram S. Cody III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerome A. Urban MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dr. Urban is deceased.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cody, H.S., Urban, J.A. Internal mammary node status: A major prognosticator in axillary node-negative breast cancer. Annals of Surgical Oncology 2, 32–37 (1995). https://doi.org/10.1007/BF02303699

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02303699

Key Words

Search

Navigation