FACO Poster Session
Discussion on indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine
演題番号 : FP1-7
1:Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, China
The internal mammary sentinel lymph node biopsy (IM-SLNB) is a minimally invasive method to assess internal mammary lymph node (IMLN) metastatic status for breast cancer. However, the IM-SLNB indication has not yet been defined in current guidelines, and it is still referred to axillary-SLNB and is performed only in clinically axilla lymph node (ALN) negative (cN0) patients, which result in low clinical benefit and limit clinical application. In this study, the impact of IM-SLNB on the diagnostic and prognostic value were analyzed both in cN0 and clinically ALN positive (cN+) patients.
Between June 2013 and September 2017, a total of 616 patients with biopsy-proven invasive breast cancer (cN0 490 and cN+ 126) were enrolled in this prospective study. The radiotracer was injected with our modified technique (periareolar intraparenchymal, high volume and ultrasonographic guidance). IM-SLNB was performed for IMLN visualized patients and clinical benefits were accessed according to current guidelines.
cN0: IM-SLNB was performed in 240 patients with IMLN visualized (visualization rate: 69.2%, 339/490). The IMLN metastases rate was 8.8%, systemic and radiotherapy treatment were changed only in 1.3% and 8.8%. However, for the patients with positive ALN and medial tumor, staging and radiotherapy treatment were changed both in 31.3%.
cN+: IM-SLNB was performed in all patients with IMLN visualized (visualization rate: 74.6%, 94/126), and the IMLN metastasis rate was 38.3%. 94 patients who underwent IM-SLNB received more accurate staging, among which 36 IMLN positive patients received internal mammary radiotherapy (IMRT), the other 58 IMLN negative patients avoided IMRT.
IM-SLNB should be routinely performed in cN+ patients and selectively in cN0 patients (IMLN high metastatic risk: positive ALN and medial tumor). Based on this IM-SLNB indication above, more accurate IMRT indication and individualized radiotherapy strategies could be put forward.