• internal mammary nodes;
  • en bloc dissection;
  • radiation therapy;
  • adjuvant therapy


The prognostic significance of tumor size and location of the primary tumor in the breast as well as the pathologic status of the axillary lymph nodes in patients with invasive primary breast cancer have been thoroughly studied. A direct adverse relationship between increasing tumor size and prognosis is well established. Likewise, even though 50% of invasive tumors are located in the upper outer quadrant of the breast, it is unusual to find statistically significant differences in survival based on quadrant location alone. Although the American College of Surgeons' (ACS) National Survey in 1978 [1] and even earlier data from Fisher et al. [2] both indicate that women with medial tumors and negative nodes do somewhat worse than patients with lateral tumors and negative nodes, this difference is, at most, 5%. Moreover, the prognosis for patients with positive nodes was not statistically different based on tumor location. However, the likelihood of axillary lymph node involvement is influenced by location of the primary tumor in the breast. In the ACS survey, 43% of patients with tumors in the lateral half of the breast had positive axillary nodes, compared with 35% for patients with medial-half tumors. Fisher has observed that 52% of patients with lateral-half tumors had positive nodes, compared with 29% of patients with medial-half tumors. This tendency occurs independent of tumor size.