title: Interpectoral nodes as the initial site of recurrence in breast cancer.
abstract: OBJECTIVE
  Interpectoral nodes can be the initial site of recurrent breast cancer.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Comprehensive breast center, located in a university-based tertiary care center.
  
  
  METHODS
  All patients undergoing operations for breast cancer at our breast center from 1995 to 2002 were reviewed.
  
  
  METHODS
  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.
authors.affiliation: Columbia-Presbyterian Medical Center, Comprehensive Breast Center, Columbia University, New York, NY, USA. ikk2001@columbia.edu
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
authors.forename: Valerie P
authors.initials: VP
authors.lastname: Bauer
authors.forename: Freya R
authors.initials: FR
authors.lastname: Schnabel
authors.forename: Kathie-Ann
authors.initials: KA
authors.lastname: Joseph
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Horowitz
authors.forename: Beth-Ann
authors.initials: BA
authors.lastname: Ditkoff
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: El-Tamer
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010369:Pectoralis Muscles / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment