July 17, 2020
How can breast reconstruction improve breast cancer staging?
Breast cancer comes in all shapes, sizes and stages. To effectively treat breast cancer, it is essential the cancer is accurately evaluated and “staged.” Breast cancer staging is based on the make-up of the tumor, lymph node involvement and metastasis throughout the body.
For most breast cancer patients, only axillary lymph nodes are biopsied and tested to determine lymph node involvement during breast cancer surgery. Patients with more advanced stage cancers, partly based on lymph node involvement, may benefit from adjuvant therapies such as chemotherapy and/or radiation. However, internal mammary lymph nodes (which are responsible for up to 30% of lymphatic drainage of the breast) are typically not dissected for staging evaluation due to limited access to the nodes during routine breast cancer surgery.
Research performed at PRMA Plastic Surgery has shown that although rare, internal mammary lymph node metastases may be identified safely at the time of free flap breast reconstruction procedures. Through internal mammary lymph node biopsy, a more comprehensive evaluation and more accurate staging of the breast cancer is made possible.
During free flap reconstruction procedures like the DIEP flap, the internal mammary lymph nodes are routinely exposed during the recipient blood vessel dissection. Once visible, the nodes can easily be dissected without adding any significant surgery time or risks to the patient.
Breast cancer metastasis to the internal mammary lymph nodes is associated with a worse prognosis than those with only axillary lymph node involvement. This is why we believe taking the extra time to biopsy the internal mammary nodes during free flap breast reconstruction is important for accurate staging of a patient’s breast cancer to ensure they receive the best treatment for their individual diagnosis.
Research Breakdown:
Among the 2,057 patients who underwent internal mammary lymph node biopsy during free flap breast reconstruction, 28 were found to have breast cancer metastasis in these nodes.
Out of the 28 patients who were found to have metastasis, 50% had already undergone chemotherapy treatment, and 53.6% had prior radiation therapy.
Of the 28 patients that were found to harbor internal mammary lymph node metastases, 10 patients did not have any metastases identified in their axillary lymph nodes. Without an internal mammary lymph node biopsy, these patients risked being undertreated due to incomplete staging information. Ultimately, 17 out of 28 patients (63%) had a change in cancer therapy based solely on the results of the internal mammary lymph node biopsy.
Author: Dr. Minas Chrysopoulo and Courtney Floyd
Research performed at PRMA Plastic Surgery shows advances in microsurgical breast reconstruction have facilitated a more comprehensive evaluation for lymphatic staging of breast cancer.
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