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Annals of Surgical Oncology

, Volume 20, Issue 10, pp 3317–3322 | Cite as

Management of Contralateral Axillary Sentinel Lymph Nodes Detected on Lymphoscintigraphy for Breast Cancer

  • Ingrid M. Lizarraga
  • Carol E. H. Scott-Conner
  • Saima Muzahir
  • Ronald J. Weigel
  • Micheal M. Graham
  • Sonia L. Sugg
Breast Oncology

Abstract

Background

Detection of a contralateral axillary sentinel lymph node (SLN) during lymphoscintigraphy for breast cancer is rare, and its significance and management are unclear. The purpose of this study was to review our experience and analyze our results together with similar patients in the literature to identify common characteristics and propose a management strategy.

Methods

A PubMed search was performed for articles describing patients in whom contralateral axillary drainage was identified on lymphoscintigraphy. Additionally, a chart review was performed of all patients who had lymphoscintigraphy for breast cancer at our institution.

Results

At our institution, two of 988 (0.3 %) consecutive patients were identified with contralateral axillary drainage on lymphoscintigraphy. Twenty-seven publications describing 105 patients with contralateral axillary drainage were found. This comprised our study group of 107 patients. Lymphoscintigraphy patterns varied depending on the history and type of prior surgery. A history of chest/axillary surgery was significantly associated with absence of an ipsilateral SLN (p < 0.05). This was observed in 84.2 % of patients with prior axillary lymph node dissection versus 33.3 % with prior SLN. Contralateral SLN biopsy was attempted in 85 patients (79.4 %); 22 (20.6 %) were positive for tumor. In 17 patients (15.9 %), the contralateral node was the only positive SLN.

Conclusions

These findings suggest that contralateral uptake on lymphoscintigraphy, though rare (0.2 %), is clinically significant and such nodes should undergo excision. Because contralateral uptake is significantly associated with prior chest/axillary surgery, routine lymphoscintigraphy should be considered in this group, as it has potential to change disease stage and management.

Keywords

Sentinel Lymph Node Sentinel Lymph Node Biopsy Internal Mammary Node Ipsilateral Axilla Sentinel Lymph Node Biopsy Result 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Ingrid M. Lizarraga
    • 1
  • Carol E. H. Scott-Conner
    • 1
  • Saima Muzahir
    • 2
  • Ronald J. Weigel
    • 1
  • Micheal M. Graham
    • 2
  • Sonia L. Sugg
    • 1
  1. 1.Department of SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  2. 2.Department of RadiologyUniversity of Iowa Hospitals and ClinicsIowa CityUSA

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