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In-transit lymph node metastases in breast cancer: a possible source of local recurrence after Sentinel Node procedure
  1. Carolien van Deurzen (carolien_van_deurzen{at}
  1. University Medical Center Utrecht, Netherlands
    1. Paul Borgstein (p.borgstein{at}
    1. Onze lieve vrouwe gasthuis, Amsterdam, Netherlands
      1. Paul van Diest (p.j.vandiest{at}
      1. University Medical Center Utrecht, Netherlands


        Aims: In-transit lymph node metastases are a common phenomenon in melanoma patients, raising more attention since the introduction of the Sentinel Node (SN) procedure. To which extent this also occurs in breast cancer patients has not been studied yet. The aim of this study was therefore to explore the occurrence of in-transit lymph node metastases in breast cancer patients.

        Methods: Afferent lymph vessels to the SN identified by blue dye were removed from 17 breast cancer patients 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 breast cancer patients. These lymph nodes may contain metastases, which is a potential source of local recurrence when left in situ.

        This finding generates a hypothesis that, if confirmed in larger series, may have major clinical impact since there may be an indication to remove these lymph vessels during the SN procedure.

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