140
Operative Findings
At operation, there was gross evidence of disease
in the axilla with nodal involvement. There was
no area of focal uptake on applying the Neoprobe
1500 in the axilla. The patient underwent qua-
A 47-year-old female presented with a lump in
her right breast. On examination, she had an ill-
defined 4 cm lump in the upper outer quadrant of
the right breast and there was a palpable axillary
lymph node. Investigations confirmed the diag-
nosis of breast cancer.
Dynamic Imaging
case
11
Internal Mammary Sentinel Node in Upper Outer Quadrant Breast Carcinoma
Dynamic imaging showed surprisingly, progres-
sion of the tracer medially towards the internal
mammary chain. There was an area of focal
uptake which was thought to be an internal mam-
mary node.
Static Imaging
Static imaging failed to show any uptake at the
axilla and confirmed the presence of an internal
mammary lymph node.
drantectomy and complete axillary node clear-
ance. It is not the policy of our surgical unit to
biopsy internal mammary lymph nodes.
Histology
Histology revealed a grade 3 invasive ductal car-
cinoma with intravascular invasion. Oestrogen
receptor was 60% positive. Six axillary lymph
nodes were involved with metastatic carcinoma,
two of which were completely replaced with
tumour. There was also evidence of extranodal
spread of cancer into axillary fat.
Teaching Points
Patients with clinically involved axillary lymph nodes should not be considered for sentinel node
biopsy.In this case, uptake in the internal mammary chain was thought to be due to a diversion of
lymph flow, as a result of a complete replacement of a number of axillary lymph nodes with meta-
static cancer. Demonstration of internal mammary nodes is, in our experience, rare. Nevertheless,
it represents a special case. There is controversy as to the significance of the sentinel node method
