title: Risk of node metastasis of sentinel lymph nodes detected in level II/III of the axilla by single-photon emission computed tomography/computed tomography.
abstract: In breast cancer, single-photon emission computed tomography/computed tomography (SPECT/CT) shows the exact anatomical location of sentinel nodes (SN). SPECT/CT mainly exposes axilla and partly exposes atypical sites of extra-axillary lymphatic drainage. The mechanism of how the atypical hot nodes are involved in lymphatic metastasis was retrospectively investigated in the present study, particularly at the level II/III region. SPECT/CT was performed in 92 clinical stage 0-IIA breast cancer patients. Sentinel lymph nodes are depicted as hot nodes in SPECT/CT. Patients were divided into two groups: With or without hot node in level II/III on SPECT/CT. The existence of metastasis in level II/III was investigated and the risk factors were identified. A total of 12 patients were sentinel lymph node biopsy metastasis positive and axillary lymph node dissection (ALND) was performed. These patients were divided into two groups: With and without SN in level II/III, and nodes in level II/III were pathologically proven. In 11 of the 92 patients, hot nodes were detected in level II/III. There was a significant difference in node metastasis depending on whether there were hot nodes in level II/III (P=0.0319). Multivariate analysis indicated that the hot nodes in level II/III and lymphatic invasion were independent factors associated with node metastasis. There were 12 SN-positive patients followed by ALND. In four of the 12 patients, hot nodes were observed in level II/III. Two of the four patients with hot nodes depicted by SPECT/CT and metastatic nodes were pathologically evident in the same lesion. Therefore, the present study indicated that the hot node in level II/III as depicted by SPECT/CT may be a risk of SN metastasis, including deeper nodes.
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shima
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Kutomi
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Fukino
authors.initials: F
authors.lastname: Satomi
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Breast Surgery Oncology, Showa University School of Medicine, Tokyo 142-8666, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takamaru
authors.affiliation: Department of Surgery, Higashi Sapporo Hospital, Sapporo 003-8585, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Kameshima
authors.affiliation: Department of Surgery, Higashi Sapporo Hospital, Sapporo 003-8585, Japan.
authors.forename: Tosei
authors.initials: T
authors.lastname: Omura
authors.affiliation: Department of Public Health, Sapporo Medical University, Sapporo 060-8556, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Diagnostic Radiology, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hatakenaka
authors.affiliation: Department of Surgical Pathology, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo 060-8543, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
keywords: atypical lymphatic drainage; breast cancer; level II; level III; sentinel node biopsy; single-photon emission computed tomography/computed tomography