Stage migration after biopsy of internal mammary sentinel lymph node in breast cancer patient

The development of sentinel lymph nodes biopsy rouses a newer interest to internal mammary lymph nodes region. We report a case of internal mammary sentinel lymph nodes biopsy of a woman with breast cancer leaded to stage migration. A 71 years old woman with upper medial quadrant left breast cancer is reported. The tumor is 2.5 cm in size. Marking of SLN with radionuclide (Tc99m) and with 2 dyes (Patent blue V and Indocyanin green) are done. Only internal mammary lymph node is established with lymphoscintigrapgy. Intraopperative only an internal mammary sentinel lymph node is discovered with gamma probe and no sentinel lymph nodes neither in the axilla nor in parasternal chain. A mastectomy with dissection ofaxillary limph nodes and excision of radiopositive internal mammary lymph node are performed. Only the iternal mammary lymph node is metastatic from all nodes (13 axillar and 1 parasternal). This fact determines the N status as N3, which is different from the N status in case of no internal mammary lymph node biopsy was performed (N0). Further treatment is based on N3 status which is different from the treatment of patients with N0 axillary status. The case is interested with the rare clinical situation of lymph metastases presence only in internal mammary lymph nodes, detect with sentinel lymph nodes biopsy. This leads to optimization of treatment.