Pulmonary lymphangitic metastasis from breast cancer. Lymphocytic alveolitis is associated with favorable prognosis.
BACKGROUND
More than 20 percent of patients with breast cancer have pulmonary lymphangitic spread at death. Previous reports have indicated that some patients may respond to aggressive chemotherapy that includes corticosteroids.


METHODS
Bronchoscopy with bronchoalveolar lavage (BAL) was used to assess pulmonary infiltrates in 14 patients with infiltrating ductal breast cancer. All patients had received prior cytotoxic or hormonal therapy. Following a diagnosis of pulmonary metastasis by BAL or biopsy specimen, all patients received prednisone and chemotherapy.


RESULTS
BAL confirmed the diagnosis of metastatic tumor in 10 of 14 patients. The conditions of the remaining patients were diagnosed by one or more other bronchoscopy specimens. Patients were divided into two groups based on BAL lymphocyte percentage (10 percent is the upper limit of normal in our laboratory). Seven patients had > 10 percent lymphocytes (high lymphs: 26 +/- 11.6 percent [mean +/- SD]) compared with seven patients with normal lymphocyte percentage (low lymphs: 4 +/- 1.9 percent, p < 0.01). Six of seven patients with low lymphs died within three months of BAL compared with one in seven patients with high lymphs (p < 0.01). Within six months, all patients with low lymphs were dead whereas five of seven patients with high lymphs were alive, (p < 0.01). Comparing the two groups, there was no significant difference in percentage of BAL neutrophils, patient age, duration of disease prior to diagnosis, or arterial-alveolar oxygen gradient.


CONCLUSIONS
In breast cancer patients with pulmonary lymphangitic metastasis, a lymphocytic alveolitis is associated with a better overall prognosis.
Lower
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Department of Medicine, University of Cincinnati Medical Center.
Baughman
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D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D001992:Bronchoalveolar Lavage Fluid; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary*; D008207:Lymphatic Metastasis; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D011650:Pulmonary Alveoli / Q000473:pathology*; D012189:Retrospective Studies