Staging of breast cancer: a new rationale for internal mammary node biopsy
M. Morrow and R. S. Foster Jr
Metastases to the axillary nodes, the internal mammary nodes, or both,
define a group of patients at very high risk of having systemic
micrometastases leading to recurrent disease and death if surgical therapy
alone is used. In our review of 7,070 patients with breast cancer in whom
both axillary nodes and internal mammary nodes were examined
histologically, 5% to 10% had internal mammary node metastases in the
absence of axillary node metastases. With the availability of effective
systemic therapy that can improve the survival of patients with operable
breast cancer who have lymph node metastases, information obtained from
internal mammary node biopsies assumes practical significance. Our current
policy is to perform internal mammary node biopsies on patients with
operable breast cancer who have medial and central primary tumors of any
size and lateral primary tumors 2 cm or greater in diameter if a frozen
section of the most suspicious node in the axillary dissection shows no
histologic evidence of metastasis.
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