J Breast Cancer.  2018 Dec;21(4):447-452. 10.4048/jbc.2018.21.e50.

Patterns of Axillary Lymph Node Metastasis in Breast Cancer: A Prospective Single-Center Study

Affiliations
  • 1Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. seokwon1.kim@samsung.com

Abstract

PURPOSE
The recent trend in breast cancer treatment is to minimize axillary dissection. However, no pattern of axillary metastasis has been precisely established. The purpose of this study was to evaluate the metastatic lymphatic pattern using near-infrared fluorescence imaging with indocyanine green (ICG) in breast cancer with cytologically proven axillary metastasis.
METHODS
This was a prospective single-center study. We evaluated 147 patients with breast cancer involving cytologically proven axillary metastasis, and compared physiological and nonphysiological lymphatic metastasis.
RESULTS
We performed lymphatic mapping for 64 patients who exhibited level II lymphatic flow on near-infrared fluorescence imaging with ICG, and found that all had axillary metastasis: 51 patients who did not receive neoadjuvant chemotherapy (NAC) and 13 patients post-NAC. Of patients who did not receive NAC, 32 had physiological lymphatic metastasis and 19 had nonphysiological lymphatic metastasis. The risk factors for nonphysiological lymphatic metastasis were age ≥55 years, high Ki-67 index (>20%), and perinodal extension in both univariate and multivariate analysis (p < 0.05).
CONCLUSION
Patients with identified risk factors in cytologically-proven axillary metastasis who did not receive NAC may have nonphysiological lymphatic metastasis.

Keyword

Axilla; Breast neoplasms; Lymphatic metastasis

MeSH Terms

Axilla
Breast Neoplasms*
Breast*
Drug Therapy
Humans
Indocyanine Green
Lymph Nodes*
Lymphatic Metastasis
Multivariate Analysis
Neoplasm Metastasis*
Optical Imaging
Prospective Studies*
Risk Factors
Indocyanine Green

Figure

  • Figure 1 Axillary lymph node dissection with lymphatic mapping on indocyanine green. (A) Axillary lymph node dissection seen in surgical field. (B) Axillary lymph node dissection seen in near-infrared fluorescence.

  • Figure 2 Classification of axillary lymph node dissection by indocyanine green. (A) Level I sentinel lymph node in near-infrared fluorescence. (B) Level I non-sentinel lymph node in near-infrared fluorescence. (C) Level II lymph node in near-infrared fluorescence.

  • Figure 3 Algorithm of axillary metastasis between physiologic lymphatic metastasis and nonphysiologic lymphatic metastasis without neoadjuvant chemotherapy.LN=lymph node; SLN=sentinel lymph node.

  • Figure 4 Algorithm of axillary metastasis between physiologic lymphatic metastasis and nonphysiologic lymphatic metastasis with neoadjuvant chemotherapy.LN=lymph node; SLN=sentinel lymph node.


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