- 作者：Elif Hindié ; M.D. ; Ph.D.&lowast ; ; ¶ ; ; elif.hindie@sls.aphp.fr ; David Groheux ; M.D.&lowast ; ; Christophe Hennequin ; M.D. ; Ph.D.&dagger ; ; Paolo Zanotti-Fregonara ; M.D. ; Ph.D.&lowast ; ; Laetitia Vercellino ; M.D.&lowast ; ; Nathalie Berenger ; M.D.&lowast ; ; Marie-Elisabeth Toubert ; M.D.&lowast ; ; Claude Maylin ; M.D.&dagger ; ; Jacques-Robert Vilcoq ; M.D.&Dagger ; ; Marc Espié ; M.D.§ ;
- 关键词：Breast cancer ; Lymphoscintigraphy ; Sentinel node biopsy ; Internal mammary node ; Radiotherapy
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：15 July, 2012
- 年：2012
- 卷：83
- 期：4
- 页码：1081-1088
- 全文大小：726 K
Purpose
Given the risk of undesired toxicity, prophylactic internal mammary (IM) chain irradiation should be offered only to patients at high risk of occult involvement. Lymphoscintigraphy for axillary sentinel node biopsy might help in selecting these patients.Methods and Materials
We reviewed published studies with the following selection criteria: ?00 breast cancer patients referred for axilla sentinel node biopsy; scintigraphy performed after peritumoral or intratumoral tracer injection; IM biopsy in the case of IM drainage; and axilla staged routinely independent of IM status.
Results
Six prospective studies, for a total of 3,876 patients, fulfilled the inclusion criteria. Parasternal drainage was present in 792 patients (20.4 % ). IM biopsy was performed in 644 patients and was positive in 111 (17.2 % ). Of the positive IM biopsies, 40 % were associated with tumors in the lateral breast quadrants. A major difference in the IM positivity rate was found according to the axilla sentinel node status. In patients with negative axilla, the IM biopsy was positive in 7.8 % of cases. In patients with positive axilla, however, the IM biopsy was positive in 41 % (p < .00001). Because biopsy of multiple IM hot nodes is difficult, the true risk could be even greater, probably close to 50 % .
Conclusions
Patients with IM drainage on lymphoscintigraphy and a positive axilla sentinel node have a high risk of occult IM involvement. These women should be considered for IM radiotherapy.