TABLE 5.
Clinical postsurgical implications of internal mammary lymph nodes IM LN metastases (n = 20)
| No. | Tumor characteristics | Axillary metastases | Postsurgical treatment | Treatment changed due to IM metastases | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| IM SLN not considered | IM SLN considered | ||||||||||
| Size (cm) | Grade (BR) | ER | (n) | CT | HT | RT | CT | HT | RT | ||
| Axilla N4+/age<70 | |||||||||||
| 1) 63, BCT | 1.5 | I | + | 7 | + | + | LR | + | + | LR | No |
| 2) 45, BCT | 1.6 | III | + | 4 | + | + | LR | + | + | LR | No |
| 3) 47, mastectomy | 1.8 | I | + | 4 | + | + | LR | + | + | LR | No |
| Axilla N1-3+/age<70 | |||||||||||
| 4) 39, mastectomy | 2.5 | II | + | 3 | + | + | BCT | + | + | BCT+PS | RT |
| 5) 46, BCT | 3.5 | III | − | 3 | + | − | BCT | + | − | BCT+PS | RT |
| 6) 58, BCT | 1.8 | II | + | 2 | + | + | BCT | + | + | BCT+PS | RT |
| 7) 45, BCT | 2.4 | I | + | 2 | + | + | BCT | + | + | BCT+PS | RT |
| Axilla N1-N1a or unfavorable primary tumor characteristics/age<70 | |||||||||||
| 8) 43, BCT | 1.8 | I | + | 1mi | − | − | BCT | + | + | BCT+PS | CT/HT/RT |
| 9) 54, BCT | 2.2 | II | + | 1mi | + | + | BCT | + | + | BCT+PS | RT |
| 10) 66, BCT | 2.5 | II | + | 1mi | − | + | BCT | − | + | BCT+PS | RT |
| 11) 50, BCT | 2.5 | III | + | 1mi | + | + | BCT | + | + | BCT+PS | RT |
| 12) 42, mastectomy | 3.0 | I | + | 1 | + | + | No | + | + | PS | RT |
| Axilla N0/favorable tumor characteristics/age<70 | |||||||||||
| 12) 54, BCT | 2.1 | I | + | 0 | − | − | BCT | + | + | BCT+PS | CT/HT/RT |
| 14) 60, BCT | 2.5 | I | + | 0 | − | − | BCT | + | + | BCT+PS | CT/HT/RT |
| 15) 67, mastectomy | 0.8 | I | + | 0 | − | − | No | − | + | PS | HT/RT |
| 16) 61, BCT | 1.1 | I | − | 0 | − | − | BCT | + | − | BCT+PS | CT/RT |
| Age>70 | |||||||||||
| 17) 82, mastectomy | 2.8 | II | + | 2 | − | + | No | − | + | PS? | RT? |
| 18) 71, BCT | 2.1 | II | + | 1 | − | + | BCT | − | + | BCT+PS | RT |
| 19) 72, BCT | 2.1 | II | + | 1mi | − | + | BCT | − | + | BCT+PS | RT |
| 20) 85, mastectomy | 0.9 | I | + | 1mi | − | − | No | − | + | PS? | HT/RT? |
BCT, breast-conserving therapy; BR, Bloom-Richardson grade; ER, estrogen receptor status; Nax+, number of positive axillary lymph nodes; IM SLN, internal mammary sentinel lymph node; ST, systemic therapy; CT, chemotherapy; HT, hormonal therapy; RT, radiotherapy; PS, parasternal radiotherapy; 1mi, micrometastases.