A Case of Locally Recurrent Breast Cancer in which Contralateral Lymph Node Metastasis was Diagnosed by Sentinel Lymph Node Biopsy

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  • Sentinel node生検で対側腋窩リンパ節転移を診断した乳房内再発乳癌の1例
  • 症例 Sentinel node生検で対側腋窩リンパ節転移を診断した乳房内再発乳癌の1例
  • ショウレイ Sentinel nodeセイケン デ タイガワエキカリンパセツ テンイ オ シンダン シタ チブサ ナイ サイハツ ニュウガン ノ 1レイ

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A 54-year-old woman was treated with breast-conserving therapy for the left breast and sentinel lymph node biopsy (SLNB) 6 years ago. Ipsilateral breast tumor recurrence occurred during the standard follow-up period. Ultrasonography showed parasternal lymph node (PsLN) metastasis. Preoperative lymphoscintigraphy revealed lymphatic drainage to the bilateral axillary nodes. The contralateral and ipsilateral axillary lymph nodes (LNs) were defined as SLNs. Total mastectomy with reoperative SLNB, PsLN dissection, and left axillary LN dissection was performed. At intraoperative histopathological examination, SLNB of the contralateral axillary node was positive for cancer. Contralateral axillary LN dissection was performed. Histologically, the PsLN and contralateral axillary sentinel node were positive for metastasis, but no further metastasis was detected in the other nodes (left axillary LN and right non-SLN) that had been removed.<BR>In this case, alteration of lymphatic flow to the PsLN occurred as a result of prior surgery. The lymphatic flow was altered again due to PsLN metastasis and the SLN was eventually detected in the contralateral axillary node region. In patients with ipsilateral breast tumor recurrence, ultrasonography before surgery might be useful to detect LN metastasis to nonaxillary nodes. Preoperative lymphoscintigraphy is recommended for identifying aberrant breast lymphatic drainage.

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