Internal mammary sentinel lymph node biopsy with modified injection technique: A case report

RATIONALE: In addition to axillary lymph node (ALN), internal mammary lymph node (IMLN) is also the first-echelon drainage nodes reached by metastasising cancer cells from breast cancer, which can provide important prognostic information. PATIENT CONCERNS: In this paper, we will introduce a case of breast cancer patient whose postoperative pathology result showed that she had internal mammary sentinel lymph node (IMSLN) metastases but no axillary sentinel lymph node (ASLN) metastases. DIAGNOSES: She was diagnosed as pT1cN1bM0 breast cancer based on the positive IMSLN but negative ASLN. INTERVENTIONS: She received axillary-sentinel lymph node biopsy (A-SLNB) and internal mammary-sentinel lymph node biopsy (IM-SLNB) guided by modified injection technique. In the choice of chemotherapy, she received dose-dense AC × 4 times followed P × 4 times for chemotherapy. As to irradiation therapy, she received irradiation therapy include chest wall, superclavicular region, and internal mammary nodes. OUTCOMES: After performing IM-SLNB, the nodal staging of this patient increased (from N0 to N1b). And she received additional chemotherapy and irradiation therapy. LESSONS: With the guidance of modified injection technique, the preoperative visualization rate of IMLN has been improved. IM-SLNB could be a minimally invasive technique for effective evaluation of the status of IMLN to provide information for staging and guide the adjuvant treatment.