Rati Chkheidze1, Mary Ann G Sanders2, Barbara Haley3, A Marilyn Leitch4, Sunati Sahoo5. 1. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX. 2. Department of Pathology, University of Louisville Hospital, Louisville, KY. 3. Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 4. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 5. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: sunati.sahoo@utsouthwestern.edu.
Abstract
BACKGROUND: Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III). PATIENTS AND METHODS: We retrospectively reviewed the medical records of breast cancer patients diagnosed with CAM for their clinical presentation, pathologic diagnoses, treatment, and follow-up data. Patients who had distant metastases at the time of CAM diagnosis were excluded from the study. RESULTS: We report 12 breast cancer patients who developed CAM but no evidence of metastases in any other distant organ documented with extensive imaging workup. Imaging studies and thorough pathologic evaluation of the prophylactic total mastectomy specimen did not reveal a primary in the breast to account for the metastases in the axillary node. CONCLUSION: Findings of our study as well as previous studies support that lymph node metastases in the contralateral axilla represents a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread. Therefore, isolated CAM in breast cancer patients should not be classified as stage IV disease.
BACKGROUND:Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III). PATIENTS AND METHODS: We retrospectively reviewed the medical records of breast cancerpatients diagnosed with CAM for their clinical presentation, pathologic diagnoses, treatment, and follow-up data. Patients who had distant metastases at the time of CAM diagnosis were excluded from the study. RESULTS: We report 12 breast cancerpatients who developed CAM but no evidence of metastases in any other distant organ documented with extensive imaging workup. Imaging studies and thorough pathologic evaluation of the prophylactic total mastectomy specimen did not reveal a primary in the breast to account for the metastases in the axillary node. CONCLUSION: Findings of our study as well as previous studies support that lymph node metastases in the contralateral axilla represents a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread. Therefore, isolated CAM in breast cancerpatients should not be classified as stage IV disease.
Authors: Francesca Magnoni; M Colleoni; D Mattar; G Corso; V Bagnardi; S Frassoni; G Santomauro; B A Jereczek-Fossa; P Veronesi; V Galimberti; V Sacchini; M Intra Journal: Ann Surg Oncol Date: 2020-05-21 Impact factor: 5.344
Authors: Amanda L Nash; Samantha M Thomas; Jennifer K Plichta; Oluwadamilola M Fayanju; E Shelley Hwang; Rachel A Greenup; Laura H Rosenberger Journal: Ann Surg Oncol Date: 2021-07-21 Impact factor: 4.339