Axillary Recurrence of Breast Carcinoma
Shabnam Jaffer, Chandandeep Nagi, Anupma Nayak, Robert Guarino, Ira J Bleiweiss. The Mount Sinai Medical Center, New York, NY
Background: Recent trials suggest that sentinel lymph node (SLN) alone provides staging information and adequate locoregional control in early stage breast cancer, with a low risk of axillary recurrence. To evaluate this, we retrospectively examined all our axillary recurrences to examine the incidence and predisposing factors.
Design: Using the pathology computerized data base (2001-2011), out of 2670 breast cancers, we identified 13 axillary recurrences. We reviewed the clinical and pathologic information on all cases.
Results: The age of the patients ranges from 35 to 86 years (average = 57.5 years). All patients underwent mastectomy, with the exception of 2 lumpectomies. Ten patients received chemotherapy, neoadjuvant in 2. The carcinomas ranged in size from 0.9cm to 3cm (average = 2.2cm) and were multifocal in 3. By morphology they were ductal (8), lobular (1) or mixed (4). Of the ductal carcinomas, 4 were micropapillary, 2 were mucinous, and 1 anaplastic. All the lobular carcinomas were pleomorphic type. Nine cases were hormone receptor positive; of the remaining 4, 3 were Her2 positive. All cases had associated high grade DCIS, (extensive in 3 cases) and lymphatic invasion. Some of the data predated the SLN era, such that this practice was observed in only 6 cases. In the remaining 7 cases, 1-20 (ave = 9) axillary lymph nodes were excised showing complete replacement with extranodal extension in 2 cases. Of the 6 SLN biopsies, 4 were replaced by metastatic carcinoma, 2 of which also had replaced axillary lymph nodes. The 2 cases with negative SLN also had negative axillary lymph nodes. Both cases were mixed type measuring 3.5 and 2.3cm. The larger one was also multifocal and the patient was not treated with chemotherapy. In the 2nd case, the patient initially declined chemotherapy for a period of 12mos. In all cases, the recurrences ranged from 2 to 7 years (average = 4 years) after the primary, all of which showed bulky disease in the axilla with extranodal disease.
Conclusions: Axillary recurrence is a rare phenomenon (0.4%), directly influenced by previous disease burden in the axilla as seen in 11 out of 13 of our cases with bulky disease. It is even more rare in patients with no evidence of disease in the axilla as seen in 2 cases with both negative SLN and axillary lymph nodes. These 2 cases probably recurred due to delayed and absent chemotherapy. Given these low recurrence rates, we would agree with the current recommendation of not excising axillary lymph nodes in patients with negative SLN and possibly with limited metastatic disease as well.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 24, Wednesday Morning