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Internal mammary node status: a major prognosticator in axillary node-negative breast cancer.

AbstractBACKGROUND: The internal mammary lymph nodes (IMN) have received little attention in recent years, yet are a well-documented site of metastasis and a major prognostic factor in early-stage breast cancer. METHODS/RESULTS: Ten-year follow-up of the final 195 patients treated by extended radical mastectomy (ERM) in this practice (selected largely on the basis of medial tumor location, and comprising 15% of all patients treated from 1965 to 1978) found IMN+ in 24% of all cases: 36% of AX+ versus 18% of AX- patients (p = 0.0023). In a multivariate analysis, the disease-free survival impact of IMN+ (p = 0.004) was second only to axillary node involvement (p < 0.0005), and surpassed tumor size (p = 0.077). IMN+ was equally frequent for tumors less than, or greater than, 2 cm (24%), and was not significantly related to patient age. Among AX- patients, there was a twofold greater risk of recurrence or death at 10 years for IMN+ than for IMN-. Among T1N0 patients, 19.6% were IMN+. CONCLUSIONS: Failure to consider IMN status in the steadily enlarging cohort of T1N0 breast cancers may result in the undertreatment of a significant proportion of stage I patients. Systemic adjuvant therapy should be considered for T1N0 patients with central or medial tumors.
AuthorsH S Cody 3rd, J A Urban (Affiliation: Department of Surgery, New York Hospital-Cornell Medical Center, New York.)
JournalAnnals of surgical oncology (Ann Surg Oncol) Vol. 2 Issue 1 Pg. 32-7 (Jan 1995) ISSN: 1068-9265 [Print] UNITED STATES
PMID7834452 (Publication Type: Journal Article)
Topics
  • Adult
  • Age Factors
  • Aged
  • Axilla (pathology)
  • Breast (pathology)
  • Breast Neoplasms (pathology, surgery)
  • Carcinoma, Ductal, Breast (pathology, secondary, surgery)
  • Carcinoma, Lobular (pathology, secondary, surgery)
  • Cause of Death
  • Cohort Studies
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Nodes (pathology)
  • Lymphatic Metastasis (pathology)
  • Mastectomy, Extended Radical
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Risk Factors

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