Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer
Introduction
Lymph node metastasis is the most important prognostic factor in breast cancer. The axilla is the most commonly involved region. Extra-axillary lymph node involvement of areas like the supraclavicular and internal mammary regions can occur, and is considered to be a more advanced regional disease than axillary metastasis according to the American Joint Committee on Cancer (AJCC) staging manual.1
Contralateral axillary metastasis (CAM) from breast cancer is uncommon.2 It is considered as distant metastasis since the contralateral axilla is not a regional draining basin of the breast. Pathological examination, in addition to clinical and radiological evaluation is essential to exclude an occult primary in the associated breast or, rarely, metastasis from another tumor outside the breast.
Management of patients with CAM is not straightforward, especially with the absence of metastatic disease elsewhere. Options include surgery, chemotherapy and hormonal therapy. In this paper we present data on 21 patients with pathologically proven CAM. A discussion of the lymphatic drainage of the breast to the contralateral axilla and the characteristics of and management options for CAM ensues.
Section snippets
Patients and methods
All patients diagnosed with breast cancer and treated at King Hussein Cancer Center during the period from 2004 to 2009 were reviewed. Patients with a confirmed pathological diagnosis of CAM were included. Core biopsy was performed in order to provide adequate pathological information, including hormone receptors and HER-2 status. A general clinical examination as well as mammography and an ultrasound evaluation of the contralateral breast were performed to exclude a contralateral primary
Results
During the study period, 21 women fulfilled the inclusion criteria. They comprised 1.9% of all our breast cancer patients during the same period. The median age at diagnosis of the primary tumors was 50 years (range 29–71). Family history of breast cancer was present in 3 patients (14%). The features of the primary tumors are shown in Table 1. Twelve of the 21 patients had a central or diffuse tumor, and most of the tumors were invasive ductal carcinomas (95%), of high grade (81%) and with
Lymphatic drainage to the contralateral axilla
Lymphatic drainage of the breast is primarily to the ipsilateral axillary lymph nodes. Drainage to other areas, like the supraclavicular and internal mammary regions is less common, and occurs in up to 25% of cases.3 Contralateral axillary drainage is uncommon but has been shown in some lymphography and sentinel lymph node studies of the breast.4, 5, 6 It is thought that blockage of or damage to the usual axillary lymphatics might lead to the development of alternative routes of drainage. This
Conclusion
Contralateral axillary metastasis in breast cancer is uncommon. It occurs mainly in patients whose tumors have aggressive pathological features. The time of development of CAM, on the other hand, might be more related to how advanced the stage is, with locally advanced tumors developing CAM earlier. Management of these patients is controversial and should be individualized. Patients with locally advanced disease should probably receive systemic therapy, as the possibility of future distant
Conflict of interest
Nothing to disclose.
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Cited by (41)
Contralateral axillary lymph node metastasis in primary breast cancer: A case report
2022, International Journal of Surgery Case ReportsCitation Excerpt :Devitt et al. reported that only 2 of 52 patients with CAM had synchronous CAM at the primary diagnosis, with most patients developing metachronous CAM 12 to 32 months later [10]. Moreover, Morcos et al. reported that 10 of 21 patients with CAM had synchronous CAM at the primary diagnosis [11], and in a case series reported by Huston et al., only 1 of 7 patients with CAM had synchronous CAM [12]. Therefore, the actual incidence of CAM, especially synchronous CAM, is probably much lower than reported in the literature.
Repeat Sentinel Lymph Node Surgery in Recurrent Breast Cancer: Peritumoral vs. Periareolar Injections
2021, Clinical Breast CancerTherapeutic options for contralateral axillary lymph node metastasis in breast cancer
2021, Current Problems in CancerCitation Excerpt :It is currently believed that the development of CAM is related to the aggressive histopathological characteristics of primary breast tumors. Morcos et al retrospectively compared 21 breast cancer patients with CAM with 401 breast cancer patients without CAM, and the results showed that breast cancer patients with CAM had significantly poorer histopathologic characteristics, including grade 3 (81%), LVI (81%), cT3-4 (95%), ER-negative (52%), and HER2 overexpression (42%).19 Moreover, when the ipsilateral lymphatic drainage pathway is disrupted, the body may establish an abnormal drainage pattern, resulting in lymphatic drainage to other lymph nodes, such as the contralateral internal mammary and contralateral axillary nodes.
Breast cancer metastasizing to the contralateral axilla several years after treatment: A case report with literature review
2021, International Journal of Surgery Case ReportsCitation Excerpt :Lymph node metastasis is the most prominent prognostic factor in breast cancer, the most prevalent region involved is the ipsilateral axilla, although extra axillary lymph nodes (include the internal mammary chain (IMC), the infraclavicular region, the supraclavicular fossa, and the interpectoral (Rotter's) space) spread can occur [1,2].