Contralateral or bilateral lymph drainage revealed by breast lymphoscintigraphy

Excerpt

Sentinel lymph node biopsy (SLNB) is a minimally invasive staging procedure for patients with breast cancer. Multiple studies have validated the accuracy of this procedure which has become the preferred and standard of practice for most surgeons treating breast cancer [1‐3]. Interestingly, a continuous evolution has been characterizing SLN mapping. In 2002, it was accepted as official component in the staging process for invasive breast carcinoma, and the American Joint Committee on Cancer Staging Manual has modified the TNM classification for breast cancer accordingly [4]. However, the American Society of Breast Surgeons had been recommending against SLN mapping for patients with significant prior axillary or breast surgery until December 2005 when the “Consensus Statement on Guidelines for Performing Sentinel Lymph Node Dissection in Breast Cancer” has been revised to include patients previously treated with surgery [5]. As far as patients with early breast cancer with no clinical evidence of lymph node (LN) involvement (cT1-T2 cN0), exclusion criteria to perform breast lymphoscintigraphy (LS) have been thinning considerably in the recent past, and the only current contraindication to perform breast LS is the presence of lymphatic congestion (i.e. mastitis) [6‐8]. Over the past 10 years, more than 12,000 breast LS have been carried out at our Institute, and only 11 cases have been characterised by contralateral or bilateral lymph drainage. Accordingly, this phenomenon has been described mostly as case report [9‐13] in literature. More recently, authors have assessed the feasibility and usefulness of LS by reviewing cohorts of patients with recurrent breast cancer previously treated with surgery [14‐20]. We here address the question with regards to what behaviour should be kept in case of display of contralateral or bilateral LNs on a LS. Should all LNs be excised and brought to pathology for examination? To what extent should this finding affect the staging and the treatment of the index breast neoplasia? …