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Objective: The aim of the study was to determine the clinical implications of internal mammary node biopsy as staging, treatment with radiotherapy and systemic treatment,and a prognostic factor in patients with breast cancer.Methods: Internal mammary node biopsy via intercostal space was performed in 229 cases of breast cancer.Anatomical location of internal mammary nodes were recorded.Pathological status of internal mammary node were detected by H & E stains.Results: Internal mammary node biopsy was successfully finished in two hundred and twenty of 229 patients.There were 126 cases(55.02%) with positive axillary nodes, while the internal mammary nodes were involved in 56 cases (24.45%).Forty-three patients(34.13%)had regional metastases in both the axillary and internal mammary lymph nodes.Thirteen (12.62%) patients had internal mammary node metastasis but no axillary node metastases.Internal mammary node positivity rates in patients with ≥4 positive axillary nodes were 49.32.%.pN stage migration was seen in 56 patients with a positive internal mammary node.There was no statistic relation between internal mammary nodes metastases and tumor location(=0.661, P=0.719).Seventy percent ofpatients with medial/central tumors and fifty percent of patients with ≥3d4 positive axillary nodes were free from internal mammary node radiotherapy on account of internal mammary node biopsy.There was no complication such as pneumothorax or haemorrhagia.Conclusions: The approach used is a reliable surgical technique for removing lymph node from intercostal space.Without exploring internal mammary nodes status, pN stage was incomplete.Internal mammary node biopsy enables treatment to be better adjusted to the needs of the individual patient.Using internal mammary node biopsy, patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas.This leads to optimization of treatment.