The conception of internal mammary sentinel lymph node biopsy (IM‐SLNB) has been added to the 2009 American Joint Committee on Cancer breast cancer staging manual. However, there has still been slight variation in the surgical treatment model owing to the low visualization rate of internal mammary sentinel lymph nodes (IM‐SLN) with the traditional radiotracer injection technique. According to the hypothesis of IM‐SLN, a modified injection technique (periareolar intraparenchymal, high volume, and ultrasound guidance) was established, which could significantly improve the IM‐SLN visualization rate, and make the IM‐SLNB procedure possible in routine practice. IM‐SLNB could provide minimally invasive staging, prognosis, and decision‐making individually, especially for the patients with clinically positive axilla lymph nodes. Moreover, radiotherapy targeting on internal mammary lymph nodes (IMLN) should be tailored and balanced between the potential benefit and toxicity, and radiotherapy guided by IM‐SLNB could achieve this goal. In the era of emphasizing the effective adjuvant therapy, within the changing therapy approach—more systemic treatment, less loco‐regional treatment—oncologist should reconsider the application of regional IMLN therapy.
Part of the book: Breast Cancer