EJSO 2003; 29: 6±8 doi:10.1053/ejso.2002.1336 FOR FURTHER DEBATE Intramammary sentinel nodes in early breast cancer: can we find them and do they matter? I. Tytler, A. Hayes and M. Kissin Breast Unit and St Lukes Cancer Centre, Royal Surrey County Hospital, Guildford, UK Intramammary nodes identified using the sentinel node biopsy technique can play an important prognostic role in early breast cancer. Two cases of intramammary nodes found by sentinel node biopsy are discussed from the Guildford perspective. # 2002 Elsevier Science Ltd. All rights reserved. Key words: breast cancer; intramammary lymph nodes; sentinel node. INTRODUCTION Upponi et al. 1 have recently presented for debate the significance of intramammary lymph nodes in breast cancer, highlighting in particular the potential of sentinel node mapping to identify these rare events. Whilst they presented breast cancer patients in which intramam- mary lymph nodes were found, none of these were as a result of the sentinel node mapping technique itself. Two of these patients underwent sentinel node mapping, but this new technique had no utility, as the intramammary sentinel node was never identified by mapping alone. In Guildford since 1997, we have performed over 500 sen- tinel node mapping procedures for breast cancer utilising the triple technique of lymphoscintigraphy, intra- operative Patent V blue dye, and a hand held gamma probe. We report two cases in which this technique successfully identified the true intramammary sentinel node prior to exploration of the axillary basin for further sentinel nodes. In one case the intramammary node was positive and the only site of metastatic disease. CASE 1 A 50-year-old woman presented with a screen detected 10 mm invasive ductal carcinoma proven on core biopsy. She underwent wide local excision and sentinel node mapping, which identified two sentinel nodes spaced well apart (Fig. 1). At operation the first sentinel node to be identified lay within the lateral substance of the breast tissue and was designated as an intramammary lymph node. It was faintly blue and surrounded by very dense parenchyma, and for this reason it did not show up on pre-operative mammograms. This node was hot with a signal-to-background count ratio of 129. Following this dissection, a second blue lymph node was found in level one of the axilla with a signal-to-background count ratio of 115, and this was deemed to be the second sentinel node. Final haematoxylin and eosin (H&E) histology showed a grade 2 invasive ductal carcinoma with associated DCIS. The intramammary sentinel node had a 1 mm focus of metastatic disease within it and the axillary node was free of disease. The tumour was oestrogen receptor positive. As the resection margins around the primary cancer were close to the DCIS, the patient elected to have a mastectomy and level one axillary clearance which identified 13 further lymph nodes, all of which were tumour free. She went on to have adjuvant chemotherapy and Tamoxifen for systemic control. 0748±7983/03/$30.00 # 2002 Elsevier Science Ltd. All rights reserved. Correspondence to: M. Kissin, Royal Surrey County Hospital, Breast Unit and St Lukes Cancer Centre, Egerton Road, Guildford GU2 7XX, UK.