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Zhao Q, Yang F, Wu HL, Mo M, Ling YX, Liu GY. Contralateral axillary lymph node metastasis in breast cancer: An oligometastatic-like disease. Breast 2023; 72:103589. [PMID: 37839139 PMCID: PMC10582740 DOI: 10.1016/j.breast.2023.103589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
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.
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Affiliation(s)
- Qian Zhao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Fan Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Huai-Liang Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yun-Xiao Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guang-Yu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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MacDonald T, Sittenfeld SMC. Goldilocks Solution Is Just Right for This Bear of a Case. Int J Radiat Oncol Biol Phys 2023; 117:527. [PMID: 37739601 DOI: 10.1016/j.ijrobp.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Taylor MacDonald
- Barrett Cancer Center, University of Cincinnati, Cincinnati, Ohio
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Nogami M, Tsujikawa T, Maeda H, Kosaka N, Takahashi M, Kinoshita N, Mori T, Makino A, Kiyono Y, Murakami T, Goi T, Okazawa H. [ 18F]FES PET Resolves the Diagnostic Dilemma of COVID-19-Vaccine-Associated Hypermetabolic Lymphadenopathy in ER-Positive Breast Cancer. Diagnostics (Basel) 2023; 13:diagnostics13111851. [PMID: 37296702 DOI: 10.3390/diagnostics13111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Coronavirus disease (COVID-19) vaccination is known to cause a diagnostic dilemma due to false-positive findings on [18F]FDG PET in vaccine-associated hypermetabolic lymphadenopathy. We present two case reports of women with estrogen-receptor (ER)-positive cancer of the breast who were vaccinated for COVID-19 in the deltoid muscle. [18F]FDG positron emission tomography (PET) demonstrated primary breast cancer and multiple axillary lymph nodes with increased [18F]FDG uptake, diagnosed as vaccine-associated [18F]FDG-avid lymph nodes. Subsequent [18F]FES PET revealed single axillary lymph node metastasis in the vaccine-associated [18F]FDG-avid lymph nodes. To the best of our knowledge, this is the first study showing the usefulness of [18F]FES PET in diagnosing axillary lymph node metastasis in COVID-19-vaccinated patients harboring ER-positive breast cancer. Thus, [18F]FES PET has potential applications in the detection of true-positive metastatic lymph nodes in patients with ER-positive breast cancer regardless of the ipsilateral or contralateral side, who have received COVID-19 vaccination.
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Affiliation(s)
- Munenobu Nogami
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
- Department of Radiology, Kobe University Hospital, Kobe 650-0017, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Hiroyuki Maeda
- First Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Mizuho Takahashi
- First Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Naoki Kinoshita
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Tetsuya Mori
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
| | - Akira Makino
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
| | - Yasushi Kiyono
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
| | | | - Takanori Goi
- First Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
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Zwimpfer TA, Schwab FD, Steffens D, Kaul F, Schmidt N, Geiger J, Geissler F, Heinzelmann-Schwarz V, Weber WP, Kurzeder C. Contralateral lymph node metastasis in recurrent ipsilateral breast cancer with Lynch syndrome: a locoregional event. World J Surg Oncol 2023; 21:40. [PMID: 36755294 PMCID: PMC9909893 DOI: 10.1186/s12957-023-02918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Contralateral axillary lymph node metastasis (CALNM) in breast cancer (BC) is considered a distant metastasis, marking stage 4cancer. Therefore, it is generally treated as an incurable disease. However, in clinical practice, staging and treatment remain controversial due to a paucity of data, and the St. Gallen 2021 consensus panel recommended a curative approach in patients with oligometastatic disease. Aberrant lymph node (LN) drainage following previous surgery or radiotherapy is common. Therefore, CALNM may be considered a regional event rather than systemic disease, and a re-sentinel procedure aided by lymphoscintigraphy permits adequate regional staging. CASE REPORT Here, we report a 37-year-old patient with Lynch syndrome who presented with CALNM in an ipsilateral relapse of a moderately differentiated invasive ductal BC (ER 90%, PR 30%, HER2 negative, Ki-67 25%, microsatellite stable), 3 years after the initial diagnosis. Lymphoscintigraphy detected a positive sentinel LN in the contralateral axilla despite no sign of LN involvement or distant metastases on FDG PET/CT or MRI. The patient underwent bilateral mastectomy with sentinel node dissection, surgical reconstruction with histological confirmation of the CALNM, left axillary dissection, adjuvant chemotherapy, and anti-hormone therapy. In addition to her regular BC follow-up visits, the patient will undergo annual colonoscopy, gastroscopy, abdominal, and vaginal ultrasound screening. In January 2023, the patient was free of progression for 23 months after initiation of treatment for recurrent BC and CALNM. CONCLUSION This case highlights the value of delayed lymphoscintigraphy and the contribution of sentinel procedure for local control in the setting of recurrent BC. Aberrant lymph node drainage following previous surgery may be the underlying cause of CALNM. We propose that CALNM without evidence of systemic metastasis should be considered a regional event in recurrent BC, and thus, a curative approach can be pursued. The next AJCC BC staging should clarify the role of CALNM in recurrent BC to allow for the development of specific treatment guidelines.
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Affiliation(s)
- Tibor A. Zwimpfer
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Fabienne D. Schwab
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Daniel Steffens
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Felix Kaul
- grid.410567.1Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Noemi Schmidt
- grid.410567.1Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - James Geiger
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Franziska Geissler
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Walter P. Weber
- grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Christian Kurzeder
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
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Zhang L, Wang XZ, Li C, Yu Q, Liu Z, Yu ZY. Contralateral Axillary Lymph Node Metastasis of Breast Cancer: Retrospective Analysis and Literature Review. Front Oncol 2022; 12:869397. [PMID: 35494019 PMCID: PMC9047860 DOI: 10.3389/fonc.2022.869397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundContralateral axillary lymph node metastasis (CAM) is classified as distant metastasis in guidelines, but the prognosis is better than that of stage IV patients. It is controversial to classify CAM as a distant metastasis or a regional metastasis, and the optimal treatment strategy for CAM is unknown.Patients and MethodsBreast cancer patients who were confirmed by pathology and treated at Shandong Cancer Hospital between January 2012 and July 2021 were included in our study. We retrospectively reviewed the medical records of the patients for their clinical features, pathological diagnosis, treatment strategy, and follow-up data. Survival analysis was calculated by Kaplan–Meier analysis, and patient matching was performed by case–control matching.ResultsA total of 60 patients were included, and there were 49 metachronous CAM cases and 11 synchronous CAM cases. The prognosis of isolated CAM patients was better than that of patients with other distant metastases in terms of CAM-OS and PFS with significant differences (median CAM-OS 71.0 vs. 30.0 months, P=0.022; median PFS 42.0 vs. 11.0 months, P=0.009) and OS without significant differences (median OS 126.0 vs. 79.0 months, P=0.111). The five-year survival rate of isolated CAM patients was 67.4%, and the five-year disease-free survival (DFS) rate was 52.9%. The prognosis of CAM patients was similar to that of N3M0 patients in terms of OS (mean OS 82.4 vs. 65.6 months, P=0.537) and DFS (mean PFS 54.5 vs. 52.6 months, P=0.888). Axillary lymph node dissection (ALND) or low-middle level ALND significantly improved the OS (mean OS 237.4 vs. 111.0 months, P=0.011), CAM-OS (mean CAM-OS 105.2 vs. 46.6 months, P = 0.002), and PFS (mean PFS 92.3 vs. 26.9 months, P = 0.001) of isolated CAM patients. Axillary radiotherapy improved PFS, CAM-OS, and OS but without significant differences (mean PFS 80.0 vs. 46.6 months, P = 0.345; mean CAM-OS 86.8 vs. 72.1 months, P = 0.338; mean OS 147.6 vs. 133.0 months, P = 0.426).ConclusionCAM should be diagnosed as local recurrence and treated with aggressive and curative rather than palliative strategies. Contralateral axillary surgery and radiotherapy are recommended for isolated CAM patients.
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Affiliation(s)
- Liang Zhang
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xin zhao Wang
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chao Li
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Yu
- Interventional Radiology, University of Chicago, Chicago, IL, United States
| | - Zhaoyun Liu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhi yong Yu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Zhi yong Yu,
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Goh IY, Dauway EL. Synchronous contralateral axillary lymph node metastasis in a recurrent breast cancer following previous axillary clearance. BMJ Case Rep 2022; 15:e248741. [PMID: 35354567 PMCID: PMC8968533 DOI: 10.1136/bcr-2022-248741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
Ipsilateral axillary lymph node metastasis is common, while contralateral axillary lymph node metastasis (CAM) is uncommon. This report is of a patient that presented with a recurrence of left breast cancer and synchronous CAM, with a distant history of left breast conserving surgery and axillary dissection for invasive carcinoma. The CAM was confirmed following a non-routine lymphoscintigraphy and sentinel lymph node biopsy. This highlights the possibility of CAM representing as locoregional disease rather than advanced stage IV disease.
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Affiliation(s)
- Ian Y Goh
- Department of Surgery, Hervey Bay Hospital, Pialba, Queensland, Australia
| | - Emilia L Dauway
- Department of Surgery, Hervey Bay Hospital, Pialba, Queensland, Australia
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7
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Yoneyama K, Nakagawa M, Hara A. Contralateral axillary lymph node metastasis in primary breast cancer: A case report. Int J Surg Case Rep 2022; 92:106810. [PMID: 35180589 PMCID: PMC8857439 DOI: 10.1016/j.ijscr.2022.106810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Contralateral axillary lymph node metastasis (CAM) is rare, especially in primary breast cancer. Presentation of case A 71-year-old woman visited our hospital after noticing a mass in her right breast. A mass of 5 cm in diameter with skin infiltration was palpable on the medial side of the right breast. She underwent a needle biopsy and was diagnosed with invasive ductal carcinoma. On various imaging modalities, there were no distant metastases but bilateral axillary lymph node metastases were found. She underwent preoperative chemotherapy and showed a clinical partial response. After thorough discussion, she opted for surgery and underwent partial mastectomy of the right breast and bilateral axillary lymph node dissection. Histopathological examination revealed residual breast tumor and one metastatic axillary lymph node on each side. Postoperative radiotherapy and hormone therapy were performed. The patient is alive and recurrence-free as of 1 year after the start of treatment. Conclusion CAM is often regarded as distant metastasis, but can be considered curable if there is no distant metastasis to other organs. CAM without distant metastasis to other organs should be treated with curative intent in order to avoid a disadvantage to the patient. The case was primary breast cancer with contralateral axillary lymph node metastasis. This was metastasis of true primary breast cancer and is rare. The patient is alive without recurrence as of 1 year after multimodal treatment. Contralateral axillary lymph node metastasis can be treated with curative intent.
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Affiliation(s)
- Kimiyasu Yoneyama
- Department of Breast Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
| | - Motohito Nakagawa
- Department of Breast Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Asuka Hara
- Department of Breast Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
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Lakshmi HN, Sharma M, Puj KS, Pandya SJ. Contralateral Axillary Metastasis in Breast Carcinoma: Case Report and Review of Literature. Niger J Surg 2021; 27:84-86. [PMID: 34012251 PMCID: PMC8112369 DOI: 10.4103/njs.njs_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/19/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
The clinical dilemma of management of isolated contralateral axillary metastasis (CAM) in carcinoma breast remains unsolved. We report a case of metachronous contralateral left axillary metastasis in a 54-year-old postmenopausal woman, its management, and review of literature. After ruling out distant metastasis and occult primary in the opposite breast, curative treatment was planned. She underwent left axillary lymph node dissection which on histopathology showed metastatic carcinoma. Management of CAM with curative or palliative intent and whether to consider them as locoregional or distant metastasis remains controversial. CAM may occur due to the locoregional spread of disease, and hence, curative intent of treatment should be offered to these patients.
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Affiliation(s)
- Harish Neelamraju Lakshmi
- Breast and Thoracic Unit 1, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Breast and Thoracic Unit 1, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ketul S Puj
- Breast and Thoracic Unit 1, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank J Pandya
- Breast and Thoracic Unit 1, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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9
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Li S, Xie F, Li Y, Wang J, Chen R, Zhu QN, Zha XM. Contralateral axillary lymph node metastasis and molecular changes in second primary breast cancer: a case report. Gland Surg 2021. [PMID: 33968707 DOI: 10.21037/gs-21-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Shuo Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Xie
- Breast Disease Department, the Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jue Wang
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Chen
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Nan Zhu
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Zha
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Salih AM, Hammood ZD, Hassan MN, Baba HO, Muhialdeen AS, Abdullah IY, Abdulla BA, Kakamad FH, Mustafa SM, Mohammed SH, Mustafa MQ. Breast cancer metastasizing to the contralateral axilla several years after treatment: A case report with literature review. Int J Surg Case Rep 2021; 82:105900. [PMID: 33962262 PMCID: PMC8113825 DOI: 10.1016/j.ijscr.2021.105900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Lymph node metastasis is the most prominent prognostic factor in breast cancer. The aim of this paper is to report a case of contralateral axillary lymph node metastasis (CAM) which look like metachronous initially, but histopathologicaly confirmed as synchronous CAM. Case presentation A-44-year old female was a known case of left breast cancer five years prior to this presentation (T2,N2,M0, grade III, Triple negative, multifocal invasive ductal carcinoma). On follow up, multiple contralateral axillary suspicious lymph nodes were discovered. Fine Needle Aspiration Cytology from the lesion revealed grade III, Triple negative, invasive ductal carcinoma consistent with metastasis from the left invasive ductal carcinoma. Bilateral mastectomy and right axillary dissection were performed. The histopathological examination and immunohistochemistry showed left breast recurrent 0.5 cm grade III, Triple negative invasive ductal carcinoma. Discussion If a cancer is found in the contralateral axilla, three main potential sources should be considered: contralateral spread from the original breast tumor, metastasis from an occult primary in the ipsilateral breast, and metastasis from an extramammary site. Conclusion Although CAM in patients with breast cancer is an uncommon condition, it is still possible to occur. There is a controversy regarding the appropriate management. Lymph node metastasis is the most prominent prognostic factor in breast cancer. Ipsilateral axillary lymphnode metastasis is the most common site of involvement. Contralateral axillary lymphnode metastasis is an unusual finding. In this paper, a case of synchronous contralateral axillary lymph node metastasis has been discussed.
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Affiliation(s)
- Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Marwan N Hassan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Aso S Muhialdeen
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Ismael Y Abdullah
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq.
| | - Shevan M Mustafa
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Mohammed Q Mustafa
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Department of Medical Analysis, Tishk International University, Erbil, Kurdistan Region, Iraq
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11
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Li S, Xie F, Li Y, Wang J, Chen R, Zhu QN, Zha XM. Contralateral axillary lymph node metastasis and molecular changes in second primary breast cancer: a case report. Gland Surg 2021; 10:1547-1552. [PMID: 33968707 DOI: 10.21037/gs-20-708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Shuo Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Xie
- Breast Disease Department, the Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jue Wang
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Chen
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Nan Zhu
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Zha
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Herrera-Martínez Y, Acevedo-Bañez I, De-Bonilla-Damiá Á, Fernández-Rodríguez P, Sousa JM, Jiménez-Hoyuela García JM. Contralateral Axillary Lymph Node Metastasis in a Patient with Relapsed Breast Cancer: Locoregional Event or Distant Metastasis Disease? Oncol Res Treat 2021; 44:128-131. [PMID: 33440391 DOI: 10.1159/000513661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contralateral axillary lymph node metastasis (CAM) is a rare clinical condition in patients with breast cancer. It can be explained from hematogenous spread from the original primary tumor (stage IV) to aberrant regional lymphatic drainage to the contralateral axilla. However, according to the current clinical guidelines, regardless of its origin, CAM is considered as metastatic disease. CASE PRESENTATION A 68-year-old woman presented with relapsed right breast cancer; lymphoscintigraphy showed only one sentinel lymph node (SLN) in the contralateral axilla (left region). Twenty-four hours later, the patient underwent upper internal quadrantectomy and bilateral selective lymph node biopsy. The final pathological analysis revealed one contralateral macrometastasis (>4 mm) in one left SLN. Subsequently, second-level left lymphadenectomy was performed. Currently the patient is being treated with chemotherapy, with appropriate clinical response. DISCUSSION Our patient was considered to be node-positive rather than having metastatic disease since the preoperative lymphoscintigraphy demonstrated contralateral lymphatic drainage. Through preoperative scan in patients with relapsed breast cancer with clinically negative lymph nodes and CAM, it is possible to identify those cases that would benefit from therapy with curative intention.
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Affiliation(s)
| | - Irene Acevedo-Bañez
- Department of Nuclear Medicine, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - José María Sousa
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen del Rocío, Seville, Spain
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Therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Curr Probl Cancer 2021; 45:100706. [PMID: 33468335 DOI: 10.1016/j.currproblcancer.2020.100706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
Contralateral axillary lymph node metastasis (CAM) in breast cancer is rare, and the reason is unclear. CAM may be found at the time of primary breast cancer diagnosis or following primary tumor treatment. CAM staging and treatment methods are controversial. Hence, we summarized the features of CAM patients and explored the therapeutic options. We report the case of an 82-year-old woman with right breast cancer accompanied by CAM. The records of breast cancer patients with CAM in PubMed (January 2000-May 2020) were also reviewed. After undergoing comprehensive treatments (neoadjuvant chemotherapy, surgery, radiotherapy, endocrine therapy, and targeted therapy), no signs of recurrence and metastasis were noted during the 25-month follow-up. Overall, 17 studies (36 patients) were selected for the review, of which 15 had synchronous CAM and 21 had metachronous CAM. Nineteen of 22 patients had histologic grade 3. Forty percent (12/30) had ≥4 positive lymph nodes. Among these 36 patients, 9 had triple-negative breast cancers, and 9 were human epidermal growth factor receptor 2 positive. Among the 30 patients staged, 6 (20%) were in stage I; 7 (23.33%), stage II; and 17 (56.67%), stage III. Two patients received systemic therapy, while one received an unknown treatment. The remaining 33 patients all received local treatment (surgery or radiotherapy). The survival time of synchronous and metachronous CAM patients was 12-72 months with the death rate of 1/7 and 12-144 months with that of 3/12, respectively. CAM may be a regional manifestation rather than a distant metastasis. Comprehensive treatment, including surgery and radiotherapy, may provide better control.
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Rebol J, Balon P, Kokol P, Švagan M. Distribution of Neck Metastases and Survival in Patients with Breast Carcinoma. Oncol Res Treat 2020; 43:380-387. [PMID: 32564015 DOI: 10.1159/000508138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Neck metastases in breast carcinoma are relatively rare and patients show poor survival rates. A controversy exists over whether neck metastases can be treated as distant or loco-regional metastases. The literature concerning the distribution of metastases in the neck is lacking, as well as data about whether metastases in the higher neck regions cause poorer survival than those in the supraclavicular fossa. METHODS Ultrasound investigation with fine-needle biopsy was performed on 41 breast cancer and confirmed neck metastases patients in a 6-year period. We analysed the distribution of neck metastases and patient survival rates using Kaplan-Meier survival curves and Cox regression. RESULTS The median survival time from the diagnosis of primary disease to that of neck metastases was 21 months. The presence of metastases in sites other than the neck significantly worsened survival, but multiple metastatic sites did not make it significantly worse. The number of nodes and presence of conglomerates did not considerably affect survival. CONCLUSION Neck metastases in breast carcinoma can be found not only in the supraclavicular fossa, but elsewhere in the neck as well. Survival of patients with metastases in higher neck regions was shorter, but not very much so. Survival of patients with metastases limited just to the neck was substantially better, therefore early detection and aggressive treatment that could include neck dissection should be considered.
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Affiliation(s)
- Janez Rebol
- Department of Otorhinolaryngology and Maxillofacial Surgery, Maribor University Clinical Center, Maribor, Slovenia, .,Medical Faculty, University of Maribor, Maribor, Slovenia,
| | - Peter Balon
- Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Peter Kokol
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Matija Švagan
- Department of Otorhinolaryngology and Maxillofacial Surgery, Maribor University Clinical Center, Maribor, Slovenia
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Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Ann Surg Oncol 2020; 27:4488-4499. [PMID: 32436193 DOI: 10.1245/s10434-020-08605-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - M Colleoni
- Division of Breast Cancer Medical Treatments, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D Mattar
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Corso
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - S Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- Service of Data Management, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - P Veronesi
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - V Sacchini
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - M Intra
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Magnoni F, Intra M. ASO Author Reflections: Future View: A Recent Scientific Contribution Towards a Staging Revision of Contralateral Axillary Lymph Node Metastases from Breast Cancer. Ann Surg Oncol 2020; 27:4500-4501. [PMID: 32430751 DOI: 10.1245/s10434-020-08612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Mattia Intra
- Department of Surgery, European Institute of Oncology, IRCCS, Milan, Italy
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