Internal Mammary Node Evaluation And Elective Nodal Treatment In Medial Breast Cancers: A Case Report And Review Of The Literature.

The evaluation and treatment of the internal mammary nodes (IMNs) in patients with axillary node positive breast cancer undergoing breast conservation therapy is somewhat controversial. A recently reported randomized trial of radiation therapy to the local regional nodes (including the IMNs) in patients undergoing breast conservation therapy demonstrated an improvement in disease free survival and overall survival with this additional nodal irradiation. For patients with tumors in the medial quadrants of the breast, consideration of peritumoral sentinel lymph node procedures with or without periareolar injections should be considered as demonstrated lymphatic drainage to the IMNs may indicate a greater need to consider their inclusion in adjuvant radiation therapy fields, regardless of clinical or radiographic involvement. These nodes may be treated either with a separate IMN field or partially-wide tangents. The benefits of this inclusion must be weighed against the risks of side effects of increased radiation exposure of lung, heart and contralateral breast tissue. Additional long-term data from randomized trials currently underway and maturing may help to define the risks versus the benefits of IMN elective nodal irradiation