Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge.
Patients and Methods
Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS).
Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5–500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9–7.0 years). The estimated OS was 72% at 5 years (95% CI 54–83), and 61% at 8 years (95% CI 43–75). The estimated DFS was 61% at 5 years (95% CI 44–74), and 42% at 8 years (95% CI 25–59).
These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Gingerich J, Kapenhas E, Morgani J, Heimann A. Contralateral axillary lymph node metastasis in second primary breast cancer: case report and review of the literature. Int J Surg Case Rep. 2017;40:47–9.
Vlastos G, Jean ME, Mirza, AN, et al. Feasibility of breast preservation in the treatment of occult primary carcinoma presenting with axillary metastases. Ann Surg Oncol. 2001;8:425.
Jaffer S, Goldfarb AB, Gold JE, et al. Contralateral axillary lymph node metastasis as the first evidence of locally recurrent breast carcinoma. Cancer. 1995;75:2875–8.
Moossdorff M, Vugts G, Maaskant-Braat AJG, et al. Contralateral lymph node recurrence in breast cancer: regional event rather than distant metastatic disease. A systematic review of the literature. Eur J Surg Oncol. 2015;41(9):1128–36.
Boughey JC, Ross MI, Babiera GV, et al. Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer. 2006;7:248–53.
Maaskant-Braat, AJG, Voogd, AC, Roumen RMH, et al. Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2013;138:13.
Port ER, Garcia-Etienne CA, Park J, et al. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol. 2007;14:2209.
Taback, B, Nguyen P, Hansen N, et al. Sentinel lymph node biopsy for local recurrence of breast cancer after breast-conserving therapy. Ann Surg Oncol. 2006;13:1099.
Wellner R, Dave J, Kim U, Menes TS. Altered lymphatic drainage after breast-conserving surgery and axillary node dissection: local recurrence with contralateral intramammary nodal metastases. Clin Breast Cancer. 2007;7:486–8.
Estourgie SH, Valdés Olmos RA, Nieweg OE, et al. Excision biopsy of breast lesions changes the pattern of lymphatic drainage. Br J Surg. 2007;94:1088–91.
Barranger E, Montravers F, Kerrou K, et al. Contralateral axillary sentinel lymph node drainage in breast cancer: a case report. J Surg Oncol. 2004;86:167–9.
Lizarraga IM, Sugg SL, Weigel RJ, Scott-Conner CE. Review of risk factors for the development of contralateral breast cancer. Am J Surg. 2013;206:704–8.
Trifirò G, Ravasi L, Paganelli G. Contralateral or bilateral lymph drainage revealed by breast lymphoscintigraphy. Eur J Nucl Med Mol Imaging. 2008;35:225.
Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–9.
Perre CI, Hoefnagel CA, Kroon BB, et al. Altered lymphatic drainage after lymphadenectomy or radiotherapy of the axilla in patients with breast cancer. Br J Surg. 1996;83:1258–1258.
Lim I, Shim J, Goyenechea M, et al. Drainage across midline to sentinel nodes in the contralateral axilla in breast cancer. Clin Nucl Med. 2004;29(6):346–7.
Kim SJ, Moon WK, Cho N, Chang JM. The detection of recurrent breast cancer in patients with a history of breast cancer surgery: comparison of clinical breast examination, mammography and ultrasonography. Acta Radiol. 2011;52:15–20.
Huston TL, Pressman PI, Moore A, et al. The presentation of contralateral axillary lymph node metastases from breast carcinoma: a clinical management dilemma. Breast J. 2007;13:158–64.
Morcos B, Jaradat I, El-Ghanem M. Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Eur J Surg Oncol. 2011;37:418–21.
Daoud M, Meziou M, Kharrat D, et al. Contralateral axillary lymph node metastasis of cancer of the breast. Bull Cancer. 1998;85:713–5.
Chkheidze R, Sanders MAG, Haley B, et al. Isolated contralateral axillary lymph node involvement in breast cancer represents a locally advanced disease not distant metastases. Clin Breast Cancer. 2017;18(4):298–304.
Wang W, Yuan P, Wang J, et al. Management of contralateral axillary lymph node metastasis from breast cancer: a clinical dilemma. Tumori. 2014;100(6):600–4.
Brito RA, Valero V, Buzdar AU, et al. Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: the University of Texas M.D. Anderson Cancer Center experience. J Clin Oncol. 2011;19:628–33.
Kim JY, Lee H, Kim TS, Kang HS, Kim SK. Unusual contralateral axillary lymph node metastasis in a second primary breast cancer detected by FDG PET/CT and lymphoscintigraphy. Nucl Med Mol Imaging. 2017;51(4):350–3.
Strazzanti A, Gangi S, Trovato C, et al. Contralateral lymph node metastasis in a woman with new primary breast cancer: systemic disease or locoregional diffusion? Int J Surg Case Rep. 2018;53:400–2.
Dayyat A, Sbaity E, Mula-Hussain L, et al. Treatment of contralateral axillary metastases: palliative vs curative dilemma. Ann Hematol Oncol. 2014;1(2):1006.
Schlechter BL, Yang Q, Larson PS, et al. Quantitative DNA fingerprinting may distinguish new primary breast cancer from disease recurrence. J Clin Oncol. 2004; 22:1830–8.
Agarwal A, Heron DE, Sumkin J, Falk J. Contralateral uptake and metastases in sentinel lymph node mapping for recurrent breast cancer. J Surg Oncol. 2005;92:4–8.
Roumen RM, Kuijt GP, Liem IH. Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol. 2006;32:1076–81.
Koizumi M, Koyama M, Tada K, et al. The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol. 2008; 34:365–8.
Kroon BB, Hoefnagel CA, Valdes Olmos RA, Nieweg OE. Regional lymph nodes at a distance. Ned Tijdschr Geneeskd. 2008;152:1997–2000.
Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast. 2009;18:225–7.
Tasevski R, Gogos AJ, Mann GB. Reoperative sentinel lymph node biopsy in ipsilateral breast cancer relapse. Breast. 2009;18:322–6.
van der Ploeg IM, Oldenburg HS, Rutgers EJ, et al. Lymphatic drainage patterns from the treated breast. Ann Surg Oncol. 2010;17:1069–75.
Kinoshita S, Hirano A, Kobayashi S, et al. Metachronous secondary primary occult breast cancer initially presenting with metastases to the contralateral axillary lymph nodes: report of a case. Breast Cancer. 2010;17:71–4.
Herold CI, Gaughan EM, Lamb CC, Tung NM. Second primary ipsilateral breast cancer with contralateral axillary involvement: a case report and literature review. Clin Breast Cancer. 2011;11:406–8.
Sabate M, Roca I, Cordoba O, et al. Contralateral axillary drainage in breast tumor recurrence. Rev Esp Med Nucl. 2011;30:327–8.
Kiluk JV, Prowler V, Lee MC, et al. Cox contralateral axillary nodal involvement from invasive breast cancer. Breast. 2004;23:291–4.
Nishimura S, Koizumi M, Kawakami J, Koyama M. Contralateral axillary node metastasis from recurrence after conservative breast cancer surgery. Clin Nucl Med. 2014;39:181–3.
Pasta V, Urciuoli P, Orazi V, Sottile D, et al. Contralateral axillary metastases from breast cancer. Personal experience and review of literature. Ann Ital Chir. 2014;85:260–4.
Tokmak H, Kaban K, Muslumanoglu M, et al. Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures. World J Surg Oncol. 2014;12:205.
Clemons M, Danson S, Hamilton T et al. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev. 2001; 27(2): 67–82.
Shenouda MN, Sadek BT, Goldberg SI, et al. Clinical outcome of isolated locoregional recurrence in patients with breast cancer according to their primary local treatment. Clin Breast Cancer. 2014;14(3):198–204.
Giordano SH, Buzdar AU, Smith TL, et al. Is breast cancer survival improving? Cancer. 2004;100(1):44–52.
Dellapasqua S, Bagnardi V, Balduzzi A et al. Outcomes of patients with breast cancer who present with ipsilateral supraclavicular or internal mammary lymph node metastases. Clin Breast Cancer. 2014;14(1):53–60.
Aebi S, Gelber S, Anderson SJ, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. The Lancet Oncology. 2014;15(2):156–63.
This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds. We acknowledge Claudia Crovace for her support in editing this manuscript, and Maria Grazia Villardita for her editorial assistance.
The authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Magnoni, F., Colleoni, M., Mattar, D. et al. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging?. Ann Surg Oncol 27, 4488–4499 (2020). https://doi.org/10.1245/s10434-020-08605-4