A positive intramammary lymph node does not mandate a complete axillary node dissection

BackgroundWe hypothesized that even in the face of a positive intramammary lymph node (IMLN) a negative axillary sentinel lymph node (SLN) reliably stages the axilla and complete axillary lymph node dissection (CALND) can be avoided.MethodsA literature search identified 386 publications that included IMLNs and SLN biopsies. Patients with a positive IMLN and negative axillary SLN who underwent a CALND were included. A review of our database was also performed.ResultsTwenty-one cases in the literature met our criteria. A review of our database resulted in 2 additional cases. Twenty-three patients were identified who had a positive IMLN, negative axillary SLN biopsy, and underwent a CALND. In all cases, the CALND was negative.ConclusionsAn axillary SLN biopsy accurately represents the disease status of the axilla in cases with a positive IMLN. CALND can be avoided in the setting of a positive IMLN and a negative axillary SLN biopsy.