The Experts below are selected from a list of 396 Experts worldwide ranked by ideXlab platform
Hiram S. Cody - One of the best experts on this subject based on the ideXlab platform.
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A selection algorithm for internal mammary sentinel lymph node biopsy in breast cancer.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2002Co-Authors: Jose Luiz Barbosa Bevilacqua, Patrick I. Borgen, Hiram S. Cody, G. Gucciardo, K.a. Macdonald, Virgilio Sacchini, Kimberly J. Van ZeeAbstract:Abstract Internal mammary lymph-node (IMN) metastases in breast carcinomas have a major influence on survival, comparable with the influence of axillary lymph-node metastases (ALNM). Prospective, randomized trials have demonstrated that complete IMN dissection as part of Extended Radical Mastectomy does not improve overall or disease-free survival. In the subset of patients with tumours 1 cm or less in size and no ALNM, information on IMN status would provide important information. In these cases, the presence of IMN metastases would change the staging from stage I to stage IIIB, according to the current tumour, node and metastasis classification. More importantly, it would influence these patients' adjuvant treatment. Lymphatic mapping for sentinel lymph-node (SLN) biopsy has demonstrated extra-axillary drainage in up to 35% of patients. Recent reports have demonstrated the feasibility of internal mammary sentinel lymph-node (IM-SLN) biopsy. Here we review the general prognostic and clinical significance of tumor location and lymph-node metastases in breast cancer and discuss the specific factors associated with IMN identification, metastases and treatment in the pre-SLN and SLN eras. Based on our review, we propose an algorithm for a selective approach to IM-SLN in breast cancer.
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Comprehensive review of the management of internal mammary lymph node metastases in breast cancer
Journal of the American College of Surgeons, 2001Co-Authors: Nancy Klauber-demore, Jose Luiz Barbosa Bevilacqua, Kimberly J. Van Zee, Patrick I. Borgen, Hiram S. CodyAbstract:At the suggestion of Sampson Handley, Philip Stibbe, in 1918, characterized the spread of breast cancer to the internal mammary lymph node (IMN) chain as a pattern of metastasis. In 1952, Wangensteen published the technique of Extended Radical Mastectomy. This technique, developed in an attempt to increase local control and survival in breast cancer, combined the classic Radical Mastectomy with resection of the IMN chain from the fifth intercostal space to the base of the neck. Early investigations in the 1960s and 1970s focused on the significance of IMN metastases, but the Extended Radical Mastectomy was subsequently abandoned when prospective, randomized trials failed to demonstrate a significant increase in survival. The resurgence in interest in IMN metastases seen over the last several years is a result of the advent of lymphatic mapping and sentinel lymph node (SLN) biopsy. Lymphoscintigrams show mapping to internal mammary lymph nodes in up to 35% of patients, a finding that raises questions about the role for internal mammary sentinel lymph node (IM SLN) biopsy. In an attempt to formulate guidelines for the management of IM SLNs, we critically reviewed the historical and new evidence concerning the significance of IMN metastases. In this article, we evaluate the incidence of IMN metastases, the effect of IMN metastases on survival, the effect of IMN dissection and radiation on survival, and recent results of IMN lymphoscintigraphy and SLN biopsy. Incidence of internal mammary and axillary lymph node metastases Clinical review based on the results of reports of Extended Radical Mastectomy confirms the importance of the IMN chain as a major pathway of lymphatic drainage. Among seven studies of Extended Radical Mastectomy (ERM) (totaling 4,172 breast cancer patients), the estimated incidence of IMN metastasis at the time of surgery ranged from 18% to 33% (Table 1). Fourteen percent to 24% of all patients had both IMN and axillary node (AN) metastases, whereas only 2% to 11% of patients had IMN metastases alone (Table 1). Of the 2,107 AN-positive patients, 29% to 52% had IMN metastases (Table 2). Of the 2,065 AN-negative patients, 4% to 18% had IMN metastases (Table 2).
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Internal mammary node status: A major prognosticator in axillary node-negative breast cancer
Annals of Surgical Oncology, 1995Co-Authors: Hiram S. Cody, Jerome A. UrbanAbstract:Background: 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
Yan Zheng - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic internal mammary lymph node dissection: a video demonstration.
Annals of surgical oncology, 2012Co-Authors: Hao Long, Dongrong Situ, Yan ZhengAbstract:Background Internal mammary lymph node (IMN) metastasis in breast cancer is a well-established prognostic factor of similar importance to axillary lymph node status. Although randomized controlled trials in the 1970s failed to show a survival benefit of IMN dissection during Extended Radical Mastectomy, they did demonstrate diminished survival of patients with IMN metastasis.1,2 The 2011 National Comprehensive Cancer Network Clinical Practice Guidelines recommend radiotherapy to the IMN chain that is clinically or pathologically positive. However, the direct contribution of IMN irradiation to improved survival is still controversial, while it may contribute to the increased risk of relevant cardiac mortality.3, 4, 5
Hao Long - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic internal mammary lymph node dissection: a video demonstration.
Annals of surgical oncology, 2012Co-Authors: Hao Long, Dongrong Situ, Yan ZhengAbstract:Background Internal mammary lymph node (IMN) metastasis in breast cancer is a well-established prognostic factor of similar importance to axillary lymph node status. Although randomized controlled trials in the 1970s failed to show a survival benefit of IMN dissection during Extended Radical Mastectomy, they did demonstrate diminished survival of patients with IMN metastasis.1,2 The 2011 National Comprehensive Cancer Network Clinical Practice Guidelines recommend radiotherapy to the IMN chain that is clinically or pathologically positive. However, the direct contribution of IMN irradiation to improved survival is still controversial, while it may contribute to the increased risk of relevant cardiac mortality.3, 4, 5
John P. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist
International Journal of Radiation Oncology Biology Physics, 2000Co-Authors: Gary M. Freedman, Michael Torosian, Elin R Sigurdson, Marcia Boraas, Nicolas Nicolaou, Barbara Fowble, John P. HoffmanAbstract:Abstract Purpose: The elective treatment of internal mammary lymph nodes (IMNs) in breast cancer is controversial. Previous randomized trials have not shown a benefit to the Extended Radical Mastectomy or elective IMN irradiation overall, but a survival benefit has been suggested by some for subgroups of patients with medial tumors and positive axillary lymph nodes. The advent of effective systemic chemotherapy and potential for serious cardiac morbidity have also been factors leading to the decreased use of IMN irradiation during the past decade. The recent publishing of positive trials testing postMastectomy radiation that had included regional IMN irradiation has renewed interest in their elective treatment. The purpose of this study is to critically review historical and new data regarding IMNs in breast cancer. Methods and Materials: The historical incidence of occult IMN positivity in operable breast cancer is reviewed, and the new information provided by sentinel lymph node studies also discussed. The results of published randomized prospective trials testing the value of elective IMN dissection and/or radiation are analyzed. The data regarding patterns of failure following elective IMN treatment is studied to determine its impact on local-regional control, distant metastases, and survival. A conclusion is drawn regarding the merits of elective IMN treatment based on this review of the literature. Results: Although controversial, the existing data from prospective, randomized trials of IMN treatment do not seem to support their elective dissection or irradiation. While it has not been shown to contribute to a survival benefit, the IMN irradiation increases the risk of cardiac toxicity that has effaced the value of radiation of the chest wall in reducing breast cancer deaths in previous randomized studies and meta-analyses. Sentinel lymph node mapping provides an opportunity to further evaluate the IMN chain in early stage breast cancer. Biopsy of “hot” nodes may be considered in the future to select patients who are most likely to benefit from additional regional therapy to these nodes. Conclusions: Irradiation of the IMN chain in conjunction with the chest wall and supraclavicular region should be considered only for those with pathologically proven IMNs with the goal of improving tumor regional control.
Tetsuya Taguchi - One of the best experts on this subject based on the ideXlab platform.
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Evidence-based risk factors for seroma formation in breast surgery.
Japanese journal of clinical oncology, 2006Co-Authors: Katsumasa Kuroi, Kojiro Shimozuma, Tetsuya Taguchi, Hirohisa Imai, Hiroyasu Yamashiro, Shozo Ohsumi, Shinya SaitoAbstract:Background: Seroma is a common problem in breast surgery. The aim of this systematic review was to identify risk factors for seroma formation. Methods: Articles published in English were obtained from searches of Medline and additional references were found in the bibliographies of these articles. Risk factors were graded according to the quality and strength of evidence and to the direction of association. Results: One meta-analysis, 51 randomized controlled trials, 7 prospective studies and 7 retrospective studies were identified. There was no risk factor supported by strong evidence, but there was moderate evidence to support a risk for seroma formation in individuals with heavier body weight, Extended Radical Mastectomy as compared with simple Mastectomy, and greater drainage volume in the initial 3 days. On the other hand, the following factors did not have a significant influence on seroma formation: duration of drainage; hormone receptor status; immobilization of the shoulder; intensity of negative suction pressure; lymph node status or lymph node positivity; number of drains; number of removed lymph nodes; previous biopsy; removal of drains on the fifth postoperative day versus when daily drainage volume fell to minimal; stage; type of drainage (closed suction versus static drainage); and use of fibrinolysis inhibitor. In contrast, sentinel lymph node biopsy reduced seroma formation. Evidence was weak, or unproven, for other factors that were commonly cited in the literature. Conclusions: Although a number of factors have been correlated with seroma formation, strong evidence is still scarce. However, there is evidence showing that sentinel lymph node biopsy reduces seroma formation.
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Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer.
Annals of surgery, 2003Co-Authors: Kenzo Shimazu, Hiroki Koyama, Akira Wada, Tetsuya Taguchi, Yasuhiro Tamaki, Kazuyoshi Motomura, Hideo Inaji, Tsutomu Kasugai, Shinzaburo NoguchiAbstract:Since Halsted identified the internal mammary chain as a route of metastasis of breast cancer a century ago, many studies have confirmed that the internal mammary node (IMN) is a second regional basin in breast cancer. Metastases to this basin were studied intensively during the period from 1960 to 1980 when Extended Radical Mastectomy, including IMN dissection, was a standard surgical procedure. This surgical procedure was later abandoned, however, because randomized trials failed to demonstrate the efficacy of IMN dissection in improving prognosis. 1–3 Since then, the IMN has been virtually ignored for two decades. However, recent development of the sentinel lymph node (SLN) biopsy technique has renewed our interest in the IMN, as focal accumulation of radioactivity in the IMN region is occasionally visualized in preoperative lymphoscintigraphy for SLN biopsy, 4,5 and because such information is considered valuable in deciding the indication for biopsy or adjuvant radiotherapy of the IMN. 6 According to earlier studies of lymphatic anatomy, some lymph from the breast gland is transported through the lymphatics penetrating the pectoralis major muscle into the internal mammary basin. 7,8 In our experience of SLN biopsy using peritumoral injection of blue dye, we have sometimes identified several blue-stained lymphatics penetrating the pectoralis major muscle when dissecting the breast parenchyma from the muscle. 9 In addition, Haagensen described another important lymphatic route from the breast comprising a vertical group of lymphatics extending from the dorsal surface of the breast to the axillary basin through the retromammary space. 10 Taken together, these observations lead us to hypothesize that some lymph, especially that from the parenchyma under the tumor, drains into both the IMN and axillary node. To test this hypothesis, we performed preoperative lymphoscintigraphy followed by SLN biopsy with injection of radiocolloid into the parenchyma underneath the tumor in breast cancer patients.
