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Annals of Oncology Advance Access published online on May 7, 2008
Annals of Oncology, doi:10.1093/annonc/mdn183
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series

U. Veronesi1,2,*, P. Arnone2, P. Veronesi2,6, V. Galimberti2, A. Luini2, N. Rotmensz3, E. Botteri3, G. B. Ivaldi4, M. C. Leonardi4, G. Viale5,6, A. Sagona2, G. Paganelli7, R. Panzeri8 and R. Orecchia4

1 European Institute of Oncology
2 Division of Senology
3 Division of Epidemiology and Biostatistics
4 Division of Radiotherapy
5 Division of Pathology, European Institute of Oncology
6 University of Milan School of Medicine
7 Division of Nuclear Medicine
8 Division of Anesthesiology, European Institute of Oncology, Milano, Italy

* Correspondence to: Prof. U. Veronesi, Istituto Europeo di Oncologia, Via G. Ripamonti, 435, 20141 Milano, Italy. Tel: +39-0257-489-225; Fax: +39-0257-489-210; E-mail: umberto.veronesi{at}ieo.it

The ‘regional nodal mapping’, is a fundamental step to stage breast carcinoma. In addition to the axillary nodes status, the involvement of internal mammary nodes is an important prognostic factor. Six hundred and sixty-three patients with breast carcinoma, mainly in the inner quadrants, underwent a biopsy of internal mammary nodes. Positive internal mammary nodes were found in 68 out of 663 cases (10.3%) representing 27.2% of all cases with regional node metastases (250). When histologically proven metastases were detected, radiotherapy was administered to the internal mammary nodes chain. In 254 cases, the surgeon's exploration was guided by a gamma probe. Out of these cases, 28 (11.0%) showed metastatic involvement. Out of the other 409 cases, not radioguided, 40 showed positive nodes (9.8%). Patients with internal mammary metastases treated with radiotherapy and appropriate systemic treatment showed an excellent survival (95% at 5 years), a result which is in opposition to the previous experience, which stated that invasion of internal mammary nodes is an ominous prognostic sign. We assume that this excellent result is due to radiotherapy to internal mammary nodes and we propose that exploration of internal mammary nodes should be part of the staging process of carcinomas of the medial part of the breast.

axillary lymph nodes, breast cancer, internal mammary nodes

Received for publication February 6, 2008. Accepted for publication April 1, 2008.


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