Aberrant Lymphatic Drainage in the Contralateral Axilla in Patients with Isolated Ipsilateral Breast Tumor Recurrence

Jai Min Ryu,Seok Won Kim,Byung Joo Chae,Jonghan Yu,Se Kyung Lee,Seok Jin Nam,Jeong Eon Lee

doi:10.3390/jcm9041192

Jai Min Ryu, Seok Won Kim + Show 5 more

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https://doi.org/10.3390/jcm9041192

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Abstract

The management and implications of aberrant lymphatic drainage in the contralateral axilla during repeat sentinel lymph node biopsy (SLNB) in patients with isolated ipsilateral breast tumor recurrence (IBTR) are not well understood. We analyzed the outcomes of contralateral SLNB in cases of isolated IBTR compared to ipsilateral SLNB. We conducted a retrospective review of cases reported at Samsung Medical Center between 1995 and 2015. All patients with isolated IBTR that underwent ipsilateral and contralateral SLNB with clinically negative lymph nodes but lymphatic drainage on the ipsilateral or contralateral axilla were included. Among 233 patients with isolated IBTR, 31 patients underwent repeat SLNB, 11 underwent ipsilateral SLNB, and nine underwent contralateral SLNB. None of the patients showed contralateral axillary metastasis in cases with isolated IBTR in the absence of clinically suspicious drainage on the contralateral axilla. Contralateral drainage was associated with a longer interval to IBTR (68.4 vs.18.6 months, p = 0.001) and the overall median follow-up duration (102.6 vs. 45.4 months, p = 0.002). There was no significant difference in the recurrence after the second operation (1 of 11 vs. 1 of 9, p = 1.000). Only one patient in both groups experienced recurrence after the second operation. Two patients (22.2%) who underwent contralateral SLNB had lymphedema. We demonstrate that no patient had contralateral metastasis in patients with isolated IBTR in the absence of clinically suspicious drainage in the contralateral axilla. Further study is warranted to better understand and optimize the management of these rare and challenging cases.

Highlights

Sentinel lymph node biopsy (SLNB) is the standard treatment for axillary lymph node staging in patients with clinically node-negative breast cancer, replacing axillary lymph node dissection (ALND) [1,2]
Re-SLNB was attempted in 31 patients, 11 underwent ipsilateral SLNB, nine underwent contralateral SLNB due to contralateral axilla lymphatic drainage on lymphoscintigraphy, and 11 patients were designated as failed for re- SLNB because they did not uptake at lymphoscintigraphy on either axilla (Figure 1)
Management of axillary lymph nodes in patients with isolated ipsilateral breast tumor recurrence (IBTR) traditionally followed two approaches: an axillary operation was not performed if patients underwent ALND during the initial operation, or ALND without re-SLBN was performed if patients underwent SLNB alone during the initial operation

Summary

Introduction

Sentinel lymph node biopsy (SLNB) is the standard treatment for axillary lymph node staging in patients with clinically node-negative breast cancer, replacing axillary lymph node dissection (ALND) [1,2]. There is no significant difference in overall survival between breast-conserving surgery (BCS) following adjuvant radiotherapy (RTx) and total mastectomy (TM), BCS shows higher isolated ipsilateral breast tumor recurrence (IBTR) than TM [3,4,5,6]. Repeat (re-) SLNB in recurrent breast cancer cases has increased. Several studies have suggested that re-SLNB in recurrent breast cancer is feasible [8,9,10,11,12,13]. Very few reports have discussed the management and implications of aberrant lymphatic drainage after SLNB in patients with isolated IBTR, especially in the contralateral axilla. We report factors for predicting contralateral drainage, and compare the prognosis between ipsilateral and contralateral SLNB groups in patients with isolated IBTR

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