Biopsies of the internal mammary sentinel nodes may improve patients chances of survival

Surgeons at a hospital in the Netherlands are pioneering the taking of biopsies from lymph nodes behind the sternum (breast bone) at the same time as they take the more usual biopsies of the lymph nodes under the armpits, the 3rd European Breast Cancer Conference in Barcelona heard today (Friday 22 March).

Dr Fred van der Ent, a senior surgeon at Maaslandziekenhuis, in Sittard, said that this enables doctors to detect more accurately where cancer cells had spread to (metastasised) and to choose more appropriate treatments for patients. This could mean patients surviving for longer.

At the moment the axillary lymph nodes under the armpits are routinely checked to see whether breast cancer has metastasised to them. If metastases are found there then patients usually receive radiotherapy and/or chemotherapy to mop up the straying cancer cells. The status of the internal mammary (IM) lymph nodes is known to be an important prognostic factor as well, since women with IM metastases usually do less well. The sentinel node (SN) is the first lymph node to which cancer cells metastasise from the breast tumour, and the internal mammary sentinel node (IM-SN) can be identified via a scan once a radioactive tracer has been injected into the patient.

Dr van der Ent said: While performing routine axillary SN scans, which we have been doing since 1997, we frequently detected IM-SNs as well, which represented lymph drainage from the breast tumour to the IM lymph nodes. We know that the concept of the SN biopsy is valid in predicting whether there are metastases in the axillary nodes, so why then ignore the presence of IM-SNs, visible during the same scan? So, since 1997 we have been performing routine IM-SN biopsies whenever the scans detect them.

The IM-SN biopsy is more difficult to perform than an axillary SN biopsy, but complications are rare and not usually serious (in 7% of cases slight damage to the membrane round the lungs is caused, but

Contact: Emma Mason
Federation of European Cancer Societies

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