Rotter's Lymph Nodes-Do We Really Need to Remove During Axillary Clearance?

Area of Science:

• Surgical Oncology
• Breast Cancer Management
• Pathology

Background:

• Axillary dissection is standard for node-positive breast cancer.
• The role of interpectoral lymph node (IPN) removal (Rotter's nodes) is debated due to low reported involvement.
• Standardized axillary management protocols are needed to reduce recurrence and morbidity.

Purpose of the Study:

• To assess the detection rate of lymph nodes in the Rotter's region.
• To determine the metastasis rate in IPNs for node-positive breast cancer patients.
• To analyze the prognostic and therapeutic significance of IPN excision during axillary clearance.

Main Methods:

• A study of 56 patients aged ≥18 undergoing axillary clearance for node-positive breast cancer.
• Exclusion of patients with recurrence or prior neoadjuvant chemotherapy.
• Pre-operative investigations including core needle biopsy, ER, PR, and Ki-67 status assessment. Statistical analysis using Kruskal Wallis and Chi-square tests (R v 3.6.0).

Main Results:

• Interpectoral lymph nodes (IPNs) were identified in 35.71% (20/56) of patients.
• Metastasis prevalence in identified IPNs was 27.27% (9/33 node-positive patients).
• IPN metastasis was associated with larger tumor size, advanced TNM classification, lower estrogen receptor (ER)/progesterone receptor (PR) expression, and higher Ki-67 positivity.

Conclusions:

• Routine dissection and separate histopathological examination of IPNs during axillary clearance are advisable.
• IPN status provides valuable prognostic information in node-positive breast cancer.
• Inclusion of IPN assessment may refine staging and treatment strategies.