Surgical management of the axilla: do intramammary nodes matter?

BackgroundThe therapeutic significance of intramammary lymph nodes is uncertain. The purpose of this study was to identify the appropriate surgical management of the axilla in intramammary node–positive patients undergoing sentinel lymph node (SLN) biopsy.MethodsA retrospective review of consecutive patients staged between September 1996 and December 2004 was performed. Intramammary node identification and pathologic findings were compared with the status of axilla.ResultsAmong 7,140 patients, intramammary nodes were identified in 151 (2%). Positive intramammary nodes were identified in 36 patients (24%). Axillary disease was identified in 61% of intramammary node–positive patients. No additional axillary disease was identified when axillary lymph node dissection was performed in intramammary node–positive patients with negative axillary SLN biopsy results.ConclusionsThe results suggest that completion axillary lymph node dissection may be based on the status of axillary SLN biopsies in clinically node negative patients when intramammary lymph node metastases are identified in the breast specimens.