Patterns of axillary lymph node metastasis from breast cancer in Egyptian patients

Abstract EN

Background : Although axillary lymph node metastasis is one of the most important determinants of breast carcinoma prognosis and adjuvant therapy, the patterns of axillary lymph node metastasis from breast cancer remain unclear. Materials and methods : Fifty female patients with operable invasive breast cancer underwent complete axillary lymph node dissection (ALND), as part of their therapy. Forty-six patients underwent modified radical mastectomy, three underwent radical mastectomy and one underwent breast conserving surgery.

The number of positive nodes, as well as their levels were recorded.

Special group of lymph nodes at the cords of the brachial plexus, named brachial lymph nodes (BLN), were resected separately. Detailed pathological study of the tumor and detected nodes were done. Results : Thirty-seven patients (74%) were premenopausal and 26% were postmenopausal.

The median age of the studied group was 45 years.

Tumor was found in the upper outer quadrant in 50% of the cases.

Invasive duct carcinoma was the commonest histopathological type (84% )Patients with stage II constituted 84% of the total sample, while stage III were 16%.

The median number of nodes identified in the dissection was 18.5 lymph nodes. A total of 41 patients (82%) showed pathologic involvement of lymph nodes, 46% had 1 to 3 positive nodes and 24% had 4 to 9 positive nodes.

The frequency of lymph node metastasis was 80% at level I, 34% at level II, 20% At level III and 4% at BLN.

Brachial nodes were detected in 22 patients (44%).

Their number ranged from 1 to 4 with a mean of 1.86.

Only two patients (4%) had positive BLN associated with lymph node metastases at all levels of the axilla. Conclusion : In Egypt, we are still dealing with relatively advanced cases of breast cancer.

Complete ALND is advised in all patients with invasive breast cancer. BLND is specially recommended in patients with clinically positive axillary lymph nodes.