Interpectoral nodes as the initial site of recurrence in breast cancer.

HYPOTHESIS

Interpectoral nodes can be the initial site of recurrent breast cancer.

DESIGN

Retrospective review.

SETTING

Comprehensive breast center, located in a university-based tertiary care center.

PATIENTS

All patients undergoing operations for breast cancer at our breast center from 1995 to 2002 were reviewed.

MAIN OUTCOME MEASURES

Patients with interpectoral node recurrence as the initial site of recurrent breast cancer were identified.

RESULTS

During the 8-year period, 4097 patients underwent surgical management for breast cancer. During this time, 4 patients (0.1%) had recurrence at the interpectoral nodes. Three of the 4 patients were node-negative at the original operation. All lesions were mammographically occult. Preoperative needle biopsy was effective in the confirmation of malignancy. All 4 underwent excision without complications.

CONCLUSIONS

Recurrence at the interpectoral nodes can be the initial site of surgical failure. These nodes may represent the site of primary drainage in a percentage of patients. The sentinel node identification technique, therefore, should diminish the number of patients affected by recurrence at this site. In patients with a palpable mass in the infraclavicular location, however, a high index of suspicion should be maintained. Workup should include additional breast imaging and needle biopsy prior to operation.