Patterns of Axillary Lymph Node Metastasis in Breast Cancer: A Prospective Single-Center Study

• Published in: Journal of breast cancer 2018, 21(4), 88, pp.447-452
• Main Authors: Choi, Hee Jun, Kim, Jae-Myung, Ryu, Jai Min, Kim, Isaac, Nam, Seok Jin, Yu, Jonghan, Lee, Se Kyung, Lee, Jeong Eon, Kim, Seok Won
• Format: Article
• Language: English
• Subjects: Original; 일반외과학
• ISSN: 1738-6756; 2092-9900
• DOI: 10.4048/jbc.2018.21.e50

The recent trend in breast cancer treatment is to minimize axillary dissection. However, no pattern of axillary metastasis has been precisely established. The purpose of this study was to evaluate the metastatic lymphatic pattern using near-infrared fluorescence imaging with indocyanine green (ICG) in breast cancer with cytologically proven axillary metastasis. This was a prospective single-center study. We evaluated 147 patients with breast cancer involving cytologically proven axillary metastasis, and compared physiological and nonphysiological lymphatic metastasis. We performed lymphatic mapping for 64 patients who exhibited level II lymphatic flow on near-infrared fluorescence imaging with ICG, and found that all had axillary metastasis: 51 patients who did not receive neoadjuvant chemotherapy (NAC) and 13 patients post-NAC. Of patients who did not receive NAC, 32 had physiological lymphatic metastasis and 19 had nonphysiological lymphatic metastasis. The risk factors for nonphysiological lymphatic metastasis were age ≥55 years, high Ki-67 index (>20%), and perinodal extension in both univariate and multivariate analysis (