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June 1981

Staging of Breast CancerA New Rationale for Internal Mammary Node Biopsy

Author Affiliations

From the Department of Surgery, University of Vermont College of Medicine, Burlington.

Arch Surg. 1981;116(6):748-751. doi:10.1001/archsurg.1981.01380180012003

• Metastases to the axillary nodes, the internal mammary nodes, or both, define a group of patients at very high risk of having systemic micrometastases leading to recurrent disease and death if surgical therapy alone is used. In our review of 7,070 patients with breast cancer in whom both axillary nodes and internal mammary nodes were examined histologically, 5% to 10% had internal mammary node metastases in the absence of axillary node metastases. With the availability of effective systemic therapy that can improve the survival of patients with operable breast cancer who have lymph node metastases, information obtained from internal mammary node biopsies assumes practical significance. Our current policy is to perform internal mammary node biopsies on patients with operable breast cancer who have medial and central primary tumors of any size and lateral primary tumors 2 cm or greater in diameter if a frozen section of the most suspicious node in the axillary dissection shows no histologic evidence of metastasis.

(Arch Surg 1981;116:748-751)

Bonadonna P, Valagussa P, Rossi A, et al:  CMF adjuvant chemotherapy in operable breast cancer , in Jones S, Salmon S (eds): Adjuvant Therapy of Cancer II . New York, Grune & Stratton Inc, 1979, pp 227-235.
Fisher B, Redmond C, Participating NSABP Investigators:  Breast cancer studies on the National Surgical Adjuvant Breast and Colon Project (NSABP) , in Jones S, Salmon S (eds): Adjuvant Therapy of Cancer II . New York, Grune & Stratton Inc, 1979, pp 215-226.
Fisher B, Carbone P, Economou S, et al:  L-phenylalanine mustard (L-PAM) in the management of primary breast cancer: A report of early findings . N Engl J Med 1975;292:117-122.Article
Fisher B, Redmond C, Fisher E, et al:  The contribution of recent NSABP clinical trials of primary breast cancer therapy to an understanding of tumor biology: An overview of findings . Cancer 1980;46:1009-1025.Article
Turner-Warwick R:  The lymphatics of the breast . Br J Surg 1958;46:574-582.Article
Stibbe E:  The internal mammary lymphatic glands . J Anat 1918;52:257-259.
Caceres E:  Incidence of metastases in the internal mammary chain in operable cancer of the breast . Surg Gynecol Obstet 1959;108:715-720.
Urban J:  Radical mastectomy with en bloc in continuity resection of the internal mammary lymph node chain . Surg Clin North Am 1956;36:1065-1082.
Handley R, Patey D, Hand B:  Excision of the internal mammary chain in radical mastectomy: Results of 57 cases . Lancet 1956;1:457-461.Article
Valagussa P, Bonadonna P, Veronesi U:  Patterns of relapse and survival following radical mastectomy: Analysis of 716 consecutive patients . Cancer 1978;41:1170-1177.Article
Donegan W:  The influence of untreated internal mammary metastases upon the course of mammary cancer . Cancer 1977;39:533-588.Article
Veronesi U, Zingo L:  Extended mastectomy for cancer of the breast . Cancer 1967;20:677-680.Article
Dahl-Iverson E, Tobiassen T:  Radical mastectomy with parasternal and supraclavicular dissection for mammary carcinoma . Ann Surg 1969;170:889-891.Article
Bucalossi P, Veronesi U, Zingo L, et al:  Enlarged mastectomy for breast cancer: Review of 1,213 cases . AJR 1971;1:119-122.Article
Lacour J, Bucalossi P, Caceres E, et al:  Radical mastectomy versus radical mastectomy plus internal mammary dissection . Cancer 1976;37:206-214.Article
Fisher B, Slack N, Katrych D, et al:  Ten-year follow-up results of patients with carcinoma of the breast in a cooperative clinical trial: Evaluating surgical adjuvant chemotherapy . Surg Gynecol Obstet 1975;140:528-534.
Caceres E:  An evaluation of radical mastectomy and extended radical mastectomy for cancer of the breast . Surg Gynecol Obstet 1967;123:337-341.
Haagensen C: Diseases of the Breast . Philadelphia, WB Saunders Co, 1971, pp 28-52, 413-425, 635-640.
Haagensen C, Bhonslay S, Guttman R, et al:  Metastasis of carcinoma of the breast to the periphery of the regional lymph node filter . Ann Surg 1969;169:174-190.Article
McDonald J, Haagensen C, Stout A, et al:  Metastasis from mammary carcinoma to the supraclavicular and internal mammary lymph nodes . Surgery 1953;34:521-540.
Handley R, Thackery A:  The internal mammary lymph chain in carcinoma of the breast . Lancet 1949;2:276-278.Article
Andreassen M, Dahl-Iverson E, Sorenson B:  Glandular metastases in carcinoma of the breast: Results of a more radical operation . Lancet 1954;1:176-178.Article
Wyatt J, Sugarbaker E, Stanton M:  Involvement of internal mammary lymph nodes in carcinoma of the breast . Am J Pathol 1955;31:143-150.
Sugarbaker E:  Extended radical mastectomy: Its superiorit, in the treatment of breast cancer . JAMA 1964;187:136-139.Article
Pavrovsky J, Tersip K, Palecek L:  Results of radical operation for mammary gland carcinoma with revision of the parasternal space . Int Surg 1969;51:509-514.
Urban J, Marjani M:  Significance of internal mammary lymph node metastases in breast cancer . AJR 1971;1:130-136.Article
Richardson J, Meeker W, Jewell W:  The morbidity of the extended radical vs the standard radical mastectomy . J Ky Med Assoc 1972;70:537-539.
Caceres E:  Radical and extended surgery for cancer . Surg Annu 1973;5:55-67.
Livingston S, Arlen M:  The extended extrapleural radical mastectomy . Ann Surg 1974;179:260-265.Article