The Clinical Study On Lymphatic Drainage Patterns And Surgical Approach To Internal Mammary Lymph Node For The Breast Carcinoma

Prospective, randomized trials have demonstrated that complete the internal mammary node (IMN) dissection, as part of extended radical mastectomy does not improve overall or disease-free survival. By the late 1980s, internal mammary node dissection had slipped quietly into the backwater of breast cancer surgery. Yet the inability of surgery to alter the clinical outcome of these IMN positive patients led to the standard of care becoming focused solely upon axillary node staging. The long-term follow-up of patients treated with extended radical mastectomy has proved that IMN status is an important prognosticator of breast cancer. Patients with isolated IMN involvement seem to have the same outcome as those with limited axillary disease. The pathologic status of IMN must be known if breast cancer staging is to be truly accuracy. Without IMN status, patients upstaging from axillary node negative /IMN negative to axillary node negative/IMN positive, they may receive unnecessary treatments with chemotherapy or parasternal irradiation; and patients downstaging from axillary node negative/IMN positive to axillary node negative/IMN negative, they would not receive necessary chemotherapy or parasternal irradiation. There is no reliable surgical approach to internal mammary node biopsy. Without the pathologic status of IMN, treatment programs may be over or inadequacy, individualized treatment regimens cannot be come true. The observations that the superficial injection technique in the breast shows only axillary sentinel nodes and that deep injection techniques show extra-axillary sentinel nodes in some patients suggested that different parts of the breast drain to different nodes. The clinical relevance of extra-axillary sentinel nodes and particular the internal mammary sentinel node biopsy is being debated. The introduction of lymphatic mapping with sentinel node biopsy has evoked a renewed interest in the anatomy and physiology of the lymphatic system of the breast. In the past, the classic lymphatic patterns of breast were studied under no physiologic conditions (by using postmortem...