Interpectoral lymph node involvement in breast carcinoma
Sabahattin Aslan1, Bahadır Çetin1, Melih Akıncı2, Akın Önder2, Necmi Yücekule2, Abdullah Çetin3
1Ankara Onkoloji Hastanesi, I. Cerrahi Kliniği Başasistanı
2Ankara Onkoloji Hastanesi, I. Cerrahi Kliniği Asistanı
3Ankara Onkoloji Hastanesi, I. Cerrahi Kliniği Şefi
Purpose: To define the patient group who might benefit from appropriate interpectoral lymph node dissection (IPN) and to investigate skip Rotter metastases rates.
Materials and Methods: Complete axillary dissection including IPN were performed in 87 female histopathologically proven breast carcinoma patients who underwent modified radical mastectomy between 1998-2000 at Ankara Oncology Hospital. IPN group sent separately to the pathological examination. Age, menopausal status, histological diagnosis, tumoral location, tumoral mass, grade, estrogens and progesterone receptors, multicentiricity, pN stage, lymphoid capsular invasion, level I-II-III metastatic lenfoid status, and TNM stage were dependent parameters.
Results: The number of patients who had metastatic IPN were 13 (14,9%) and out of 13, 2 patients had metastatic IPN (2,3%) in the absence of axillary lymph node metastases. The independent parameters found to be statistically significant in IPN metastases are; high grade tumors, the presence of more than 2 metastatic lymph nodes, capsular invasion (pN1biii) (p<0.05). The grade was found to be most significant parameter in this study which can also be evaluated preoperatively.
Conclusion: As metastases in unexcised IPN may become a source of local or systemic treatment failure and understaging parameter, IPN should be excised carefully in breast carcinoma patients who have high grade tumors, signs of capsular invasion of the lymph nodes and who have two or more metastatic axillary lymph nodes clinically or during the operation.
Keywords: Rotter's lymph node, interpectoral, breast cancer