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. 1983 Mar;197(3):276–283. doi: 10.1097/00000658-198303000-00006

Discontinuous or "skip" metastases in breast carcinoma. Analysis of 1228 axillary dissections.

P P Rosen, M L Lesser, D W Kinne, E J Beattie
PMCID: PMC1352730  PMID: 6830335

Abstract

Patterns of axillary lymph node metastases were analyzed in 1228 recently performed modified, radical, and extended radical mastectomies. In these specimens the position or level of lymph nodes was designated intraoperatively by the surgeon. No lymph node metastases were found in 720 (58) of the specimens while the remainder (508 or 41%) had at least one affected lymph node. The distribution of involvement by level showed progressive spread from level I to III as the number of positive lymph nodes increased. Discontinuous or "skip" metastases not following this pattern occurred in 1.6% of all cases and 3% of those with lymph node metastases (95% confidence interval, 1-5%). Half of those with "skip" metastases had tumor limited to level II. The presence of "skip" metastases was not related to the size, location in the breast, or histologic type of the primary tumor. It is apparent that the potential risk from "skip" metastases is not great and that this should not be a major consideration in therapeutic decisions. The risk is likely to be negligible for women treated by axillary dissections that include level II.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BERG J. W. The significance of axillary node levels in the study of breast carcinoma. Cancer. 1955 Jul-Aug;8(4):776–778. doi: 10.1002/1097-0142(1955)8:4<776::aid-cncr2820080421>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  2. Canellos G. P., Hellman S., Veronesi U. Occasional notes. The management of early breast cancer. N Engl J Med. 1982 Jun 10;306(23):1430–1432. doi: 10.1056/NEJM198206103062321. [DOI] [PubMed] [Google Scholar]
  3. Davies G. C., Millis R. R., Hayward J. L. Assessment of axillary lymph node status. Ann Surg. 1980 Aug;192(2):148–151. doi: 10.1097/00000658-198008000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Durkin K., Haagensen C. D. An improved technique for the study of lymph nodes in surgical specimens. Ann Surg. 1980 Apr;191(4):419–429. doi: 10.1097/00000658-198004000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fisher B., Slack N. H., Bross I. D. Cancer of the breast: size of neoplasm and prognosis. Cancer. 1969 Nov;24(5):1071–1080. doi: 10.1002/1097-0142(196911)24:5<1071::aid-cncr2820240533>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  6. Fisher B., Slack N. H. Number of lymph nodes examined and the prognosis of breast carcinoma. Surg Gynecol Obstet. 1970 Jul;131(1):79–88. [PubMed] [Google Scholar]
  7. Fisher B., Wolmark N., Bauer M., Redmond C., Gebhardt M. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast. Surg Gynecol Obstet. 1981 Jun;152(6):765–772. [PubMed] [Google Scholar]
  8. Forrest A. P., Roberts M. M., Cant E., Shivas A. Simple mastectomy and pectoral node biopsy. Br J Surg. 1976 Aug;63(8):569–575. doi: 10.1002/bjs.1800630802. [DOI] [PubMed] [Google Scholar]
  9. Hellman S., Harris J. R., Levene M. B. Radiation therapy of early carcinoma of the breast without mastectomy. Cancer. 1980 Aug 15;46(4 Suppl):988–994. doi: 10.1002/1097-0142(19800815)46:4+<988::aid-cncr2820461323>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  10. Kissin M. W., Thompson E. M., Price A. B., Slavin G., Kark A. E. The inadequacy of axillary sampling in breast cancer. Lancet. 1982 May 29;1(8283):1210–1212. doi: 10.1016/s0140-6736(82)92337-6. [DOI] [PubMed] [Google Scholar]
  11. Nemoto T., Vana J., Natarajan N., Bedwani R., Mettlin C. Observations on short-term and long-term surveys of breast cancer by the American College of Surgeons. I. Significance of the number of axillary nodes and II. Estrogen receptor assay in the U.S. in 1977. Int Adv Surg Oncol. 1981;4:209–239. [PubMed] [Google Scholar]
  12. Robbins G. F., Berg J. Curability of patients with invasive breast carcinoma based on a 30-year study. World J Surg. 1977 May;1(3):284–286. doi: 10.1007/BF01556838. [DOI] [PubMed] [Google Scholar]
  13. Rosen P. P. Axillary lymph node metastases in patients with occult noninvasive breast carcinoma. Cancer. 1980 Sep 1;46(5):1298–1306. doi: 10.1002/1097-0142(19800901)46:5<1298::aid-cncr2820460535>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  14. Rosen P. P., Lesser M. L., Senie R. T., Duthie K. Epidemiology of breast carcinoma IV: age and histologic tumor type. J Surg Oncol. 1982 Jan;19(1):44–51. doi: 10.1002/jso.2930190112. [DOI] [PubMed] [Google Scholar]
  15. Rosen P. P. The pathological classification of human mammary carcinoma: past, present and future. Ann Clin Lab Sci. 1979 Mar-Apr;9(2):144–156. [PubMed] [Google Scholar]
  16. Smith J. A., 3rd, Gamez-Araujo J. J., Gallager H. S., White E. C., McBride C. M. Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis. Cancer. 1977 Feb;39(2):527–532. doi: 10.1002/1097-0142(197702)39:2<527::aid-cncr2820390221>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  17. Vana J., Bedwani R., Mettlin C., Murphy G. P. Trends in diagnosis and management of breast cancer in the U.S.: from the surveys of the American College of Surgeons. Cancer. 1981 Aug 15;48(4):1043–1052. doi: 10.1002/1097-0142(19810815)48:4<1043::aid-cncr2820480432>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]

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