Interpectoral nodes as the initial site of recurrence in breast cancer.

Hypothesis: Interpectoral nodes can be the initial site of recurrent breast cancer.

Design: Retrospective review.

Setting: Comprehensive breast center, located in a university-based tertiary care center.

Patients: All patients undergoing operations for breast cancer at our breast center from 1995 to 2002 were reviewed.

Main Outcome Measures: 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.