J Breast Dis.  2020 Jun;8(1):58-63. 10.14449/jbd.2020.8.1.58.

Surgical Management of Isolated Level III Lymph Nodes in Breast Cancer

• Park CS
• Kim HK
• Park HY

• KMID: 2504522
• DOI: http://doi.org/10.14449/jbd.2020.8.1.58

Abstract

Purpose
The incidence of isolated level III lymph node recurrence in breast cancer was evaluated, and a surgical approach with preoperative tattooing was introduced. When a suspicious infraclavicular lymph node was detected, fine-needle aspiration cytology was performed to confirm the recurrence of breast cancer. In addition, surgical excision was considered to evaluate the biological characteristics of the recurrent lesion.
Methods
The treatment strategy was determined through multidisciplinary team discussions, which included breast surgeons, plastic surgeons, oncologists, radiologists, pathologists, and radiation oncologists. Preoperative tattooing was performed, and the lymph nodes were removed after splitting the pectoralis major muscle.
Results
Among 85 cases of locoregional recurrence, isolated recurrent lymph nodes were observed in 25 cases. Three patients with an isolated recurrent infraclavicular lymph node received radiotherapy, and six patients underwent excision biopsy due to a history of radiotherapy for primary tumors. There was no failure in identifying the recurrent lymph node and no major complication.
Conclusion
The removal of isolated level III lymph node is safe, easy and can provide useful information for systemic therapy.

Keyword

Breast neoplasms; Lymph nodes; Recurrence