title: In-transit lymph node metastases in breast cancer: a possible source of local recurrence after Sentinel Node procedure.
abstract: OBJECTIVE
  In-transit lymph node metastases are a common phenomenon in melanoma patients and have been increasingly recognised since the introduction of the Sentinel Node (SN) procedure. To which extent this also occurs in patients with breast cancer has not been studied yet. The aim of this study was therefore to explore the occurrence of in-transit lymph node metastases in patients with breast cancer.
  
  
  METHODS
  Afferent lymph vessels to the SN identified by blue dye were removed from 17 patients with breast cancer during a regular SN procedure.
  
  
  RESULTS
  Three out of 17 patients showed a lymph node associated with the afferent lymph vessel. One of these lymph nodes showed a breast cancer macrometastasis, to be regarded as an in-transit metastasis. This metastasis would normally have been left in situ.
  
  
  CONCLUSIONS
  In-transit lymph nodes associated with the afferent SN lymph vessels seem to occur in a significant proportion of patients with breast cancer. These lymph nodes may contain metastases, which are a potential source of local recurrence when left in situ. This finding generates the hypothesis that there may be an indication to remove these lymph vessels during the SN procedure.
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, The Netherlands. c.vandeurzen@umcutrecht.n
authors.forename: C H M
authors.initials: CH
authors.lastname: van Deurzen
authors.forename: P J
authors.initials: PJ
authors.lastname: Borgstein
authors.forename: P J
authors.initials: PJ
authors.lastname: van Diest
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D021701:Sentinel Lymph Node Biopsy