Isolated Contralateral Axillary Lymph Node Involvement in Breast Cancer Represents a Locally Advanced Disease Not Distant Metastases

Contralateral axillary metastasis: is surgical treatment the best option?

“…However, a different outcome would be in cases of untreated breast cancer, where CAM means dissemination beyond the regional nodes. Other risk factors for CAM have been described, including obstruction of the ipsilateral lymphatic drainage, bulky tumor in the breast, extensive tumor burden in the axilla, and as mentioned before, previous surgery and/or radiotherapy [3,7] .…”

“…AJCC 8th edition classifies CAM as stage IV disease because contralateral axillary lymph nodes are not considered a regional extent of the disease, but a distant metastasis [10] . However, several publications have questioned this affirmation and proposed that treatment of CAM should be aggressive and multidisciplinary as it is in the case of locally advanced breast cancer, rather than treated as a distant metastasis [3,4,8] . A systematic review analyzed 48 patients with CAM, 23 had complete follow up data during a mean time of 50.3 months with an overall survival of 82.6%.…”

“…There are many controversies about the pathophysiology and appropriate management of CAM because the contralateral axilla is considered a distant metastasis, thus stage IV disease, with limited therapeutic strategies involved. Some authors have advised about a multidisciplinary and more aggressive approach to treat CAM, such as a loco regional spread breast cancer rather than distant metastasis [3,4] .…”

Contralateral lymph node metastasis in a woman with new primary breast cancer: Systemic desease or locoregional diffusion?

“…Breast cancer metastasis in the contralateral axillary lymph node (CAM) with no metastasis in any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III) [ 15 ]. When a cancer is found in the contralateral axilla, there are three main potential sources [ 18 ]: a)contralateral spread from the original breast tumor; b) metastasis from an occult primary tumor in the ipsilateral breast or c) metastasis from an extramammary site.…”

“…Previous studies indicate that patients with contralateral axillary lymph node metastases (CAM) have a better outcome compared to patients having a stage IV disease [ 15 ].…”