Elsevier

Surgery

Volume 145, Issue 5, May 2009, Pages 495-499
Surgery

Original Communication
Intramammary lymph nodes: Patterns of discovery and clinical significance

https://doi.org/10.1016/j.surg.2009.01.015Get rights and content

Background

We sought to determine how often axillary node metastases were present in patients with intramammary lymph node (IMLN) metastasis and if the method of IMLN discovery impacts likelihood of axillary node metastasis.

Methods

A retrospective review of our breast cancer database was conducted to identify patients in whom an IMLN was found. IMLNs were classified into 2 groups: those found “preoperatively” (evident on mammography, ultrasonography, magnetic resonance imaging or lymphogram), and those found “incidentally” (found by the surgeon intraoperatively or on pathologic review). Patterns of discovery and their correlation with axillary disease were evaluated using Fisher's exact test.

Results

Between March 1994 and October 2007, IMLNs were identified in 93 breast specimens. Twenty-three IMLNs were found preoperatively, while 70 were identified incidentally. Thirty-two patients (34%) harbored cancer in IMLNs with additional axillary node involvement present in 22 (69%). Metastasis was more frequent in the IMLNs detected by imaging (10/23, 43%) than in IMLNs detected incidentally (22/70, 31%, P = NS). Patients with positive IMLNs were more likely to have axillary disease than patients with negative IMLNs (69% versus 18%, P < .0001).

Conclusion

The majority of identified IMLNs are histologically negative. If breast cancer is identified in an IMLN, additional axillary lymph node disease is common, regardless of the method of detection of the IMLN.

Section snippets

Methods

Institutional Review Board approval was obtained and a retrospective review was conducted of our breast cancer pathology database to identify all patients in whom an IMLN had been identified between March 1994 and October 2007. Information was retrieved on: clinicopathologic features of the primary neoplasm (type, greatest dimension, grade, presence of lymphovascular invasion, and ER/PR status); axillary lymph node status (number of nodes with metastatic involvement); method of discovery and

Results

Between March 1994 and October 2007, approximately 9,800 operable breast cancers were treated at Mayo Clinic. The average mastectomy rate was 40%. IMLNs were identified in 93 breast specimens in 93 female patients. Thirty-two patients (34%) harbored cancer in IMLNs.

The median age was 68 years (range, 26–106). Of the 93 patients, 33 (35%) were premenopausal, 56 (60%) were postmenopausal, and 4 (5%) were peri-menopausal. Sixty-nine patients (74%) underwent mastectomy, and 24 patients (26%)

Discussion

The clinical implications of metastatic involvement of IMLNs have been debated since 1983, when Egan and McSweeney3 first published their experience. They found a 10% incidence of metastasis in IMLNs found at the time of pathologic evaluation. More recently, Shen et al4 and Guth et al5 have reported IMLN involvement in 28% and 31% of IMLNs respectively. These authors have also demonstrated axillary lymph node disease in 81% and 72%, respectively, of patients with a positive IMLN.

Our 69% rate of

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