Clinico-pathological study of intra-mammary lymph nodes in breast cancer

ABSTRACT

Axillary lymph node status considered the most significant factor for breast cancer outcome and treatment decision are based on the presence or absence of nodal disease. Intramammary lymph nodes [IMLNs] can be a site of regional spread. Is this a marker for more aggressive disease. This prospective study has been completed on 30 patients with [IMLNS] of breast cancer at the surgical oncology unit Al-Azhar University from February 2000 to February 2008. Their age ranged from 27 to 90 years with an average of 55 years in positive intramammary lymph nodes and their age ranged from 38 to 92 years with an average of 62 years in negative intramammary lymph node. Intramammary lymph nodes were identified in 30 breast cancer patients, with metastatic spread in 10 patients and benign IMLNs described in 20 patients. Patients without intramammary lymph nodes were excluded in this study. Positive intramammary lymph nodes were associated with more aggressive disease, including higher rates of invasive versus non invasive cancer [10% ductal carcinoma - in - situ [DCIS] with positive IMLNs versus 25% with negative IMLNs]. Lymphovascular invasion [60% vs 10%] and a higher rate of axillary lymph node involvement [75% vs. Patient with positive IMLNs were also more likely to undergo mastectomy [80% vs. 55%]. IMLNs metastasis is a marker for disease severity, recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLNs is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection-preoperative mammography and lymphoscientigraphy help identified these extra-axillary metastases