Clinical Significance of Rotter's Nodes in Patients with Breast Carcinomas

Sin, Jin Woo; Lee, Soo Jung; Jeong, Ki Ho; Kwun, Koing Bo

Abstract

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis.
METHODS
In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy.
RESULTS
The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05).
CONCLUSION
The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).