Contralateral or bilateral lymph drainage revealed by breast lymphoscintigraphy

Contralateral axillary lymph node metastasis in breast cancer: An oligometastatic-like disease

BACKGROUND

Contralateral axillary lymph node metastasis (CAM) is rare. It remains controversial whether CAM should be regarded as a regional or distant metastatic disease. Our study aims to investigate the accurate clinical orientation and management of CAM.

METHODS

Two hundred and ninety-nine female patients diagnosed with breast cancer from 2000 to 2014 and confirmed to develop CAM, oligometastasis (OM) or locoregional recurrence (LRR) at Fudan University Shanghai Cancer Center (FUSCC) were included in this study. Baseline information and survival outcomes were analyzed and compared among the three groups.

RESULTS

Patients with CAM exhibited similar overall survival (OS) and progression-free survival (PFS) to those with OM, but worse than those with LRR (HR: 0.47 [95 % CI: 0.27-0.85], p = 0.0097; HR:0.39 [95 % CI: 0.24-0.63], p < 0.0001, respectively). Considering the patients presented with CAM or OM as a whole, we found that local treatment combined with systemic treatment did not provide a superior survival benefit over systemic treatment alone.

CONCLUSION

CAM was similar to an oligometastatic-like disease, and patients with these diseases may benefit from systemic treatment. Adding local treatment failed to significantly improve OS.

Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease?

OBJECTIVE

The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease.

METHODS

A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed.

RESULTS

A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27 months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival.

CONCLUSIONS

Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.

Contralateral axillary lymph node metastasis and molecular changes in second primary breast cancer: a case report

Contralateral axillary metastasis (CAM) is rather rare in primary breast cancer. In this case, we present a 46-year-old female patient who underwent left breast-conserving surgery (BCS) and left axillary lymph node dissection (ALND). Two years later, an enlarged lymph node was found in her right axilla. Magnetic resonance imaging (MRI) of the breast displayed a left breast mass with multiple internal mammary lymph nodes and abnormal lymph nodes in the right axillary region. However, no abnormalities were found in the right breast. The left breast mass was diagnosed as invasive carcinoma by core needle biopsy. During the operation, we suggested that the contralateral lymph nodes were metastatic from the second primary breast cancer by preoperative 99mTc injection around the left breast. The patient underwent left mastectomy and right axillary lymph node dissection. The postoperative pathology was diagnosed as metachronous secondary primary left breast cancer, in which the initial presentation was lymph node metastasis to the contralateral axilla of the left breast. Therefore, we propose that CAM may be more common in second primary or recurrent breast cancer. It should be treated as locoregional extension. Preoperative lymph node markers are important to identify whether contralateral axillary lymph node metastasis occurs from a second primary breast cancer.

Contralateral axillary lymph node metastasis and molecular changes in second primary breast cancer: a case report

Contralateral axillary metastasis (CAM) is rather rare in primary breast cancer. In this case, we present a 46-year-old female patient who underwent left breast-conserving surgery (BCS) and left axillary lymph node dissection (ALND). Two years later, an enlarged lymph node was found in her right axilla. Magnetic resonance imaging (MRI) of the breast displayed a left breast mass with multiple internal mammary lymph nodes and abnormal lymph nodes in the right axillary region. However, no abnormalities were found in the right breast. The left breast mass was diagnosed as invasive carcinoma by core needle biopsy. During the operation, we suggested that the contralateral lymph nodes were metastatic from the second primary breast cancer by preoperative 99mTc injection around the left breast. The patient underwent left mastectomy and right axillary lymph node dissection. The postoperative pathology was diagnosed as metachronous secondary primary left breast cancer, in which the initial presentation was lymph node metastasis to the contralateral axilla of the left breast. Therefore, we propose that CAM may be more common in second primary or recurrent breast cancer. It should be treated as locoregional extension. Preoperative lymph node markers are important to identify whether contralateral axillary lymph node metastasis occurs from a second primary breast cancer.

Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging?

BACKGROUND

Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge.

PATIENTS AND METHODS

Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS).

RESULTS

Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59).

CONCLUSION

These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.

Contralateral lymph node recurrence in breast cancer: Regional event rather than distant metastatic disease. A systematic review of the literature

AIMS

After treatment for breast cancer, some patients experience a contralateral lymph node recurrence (CLNR). Traditionally, contralateral nodes are considered a distant site. However, aberrant lymph drainage after previous surgery is common. This might indicate that CLNR is a regional event. This study aimed to review the literature to determine prognosis after CLNR.

METHODS

PubMed was searched up until July 2014. Articles on CLNR with or without ipsilateral breast tumour recurrence (IBTR), and repeat sentinel node (SN) studies reporting on positive contralateral nodes were included. Exclusion criteria were synchronous contralateral breast cancer and synchronous distant events.

RESULTS

24 articles were included, describing 48 patients. Of these 48, 26 patients had an isolated CLNR, 7 IBTR and clinically detected CLNR, and 15 IBTR with a positive contralateral repeat SN. Isolated CLNR occurred earlier (45.9 months) than IBTR with CLNR (126.6 months, p < 0.001) or with a positive contralateral repeat SN (217.2, p = 0.02). Surgical treatment was described for 38 patients, and consisted of axillary lymph node dissection for 34 (89.5%). Information on adjuvant therapy was available for 27 patients, 21 (77.8%) received chemotherapy. Follow-up information after CLNR was available for 23 patients (47.9%). Mean follow-up was 50.3 months. Overall survival and disease-free survival were 82.6% [95% CI 67.1-98.1] and 65.2% [45.7-84.7] respectively at last follow-up.

CONCLUSIONS

Although observed in a small population, the survival of CLNR is not comparable to distant disease. Most patients received locoregional and systemic treatment suggesting a curative approach. This indicates that CLNR should be regarded as a regional event.