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Page 4 of 5 De Alcantara Filho et al. J Cancer Metastasis Treat 2019;5:2 I http://dx.doi.org/10.20517/2394-4722.2018.62

A retrospective study from the National Cancer Data Base evaluated women with clinically node-
negative breast cancer who had nodal macro or microscopic metastases in the SLN. There were no
significant differences in AR with the addition or not of ALND in macrometastasis (1.2 vs. 1, P = 0.4) and
[8]
micrometastasis (0.6 vs. 0.2, P = 0.063) . When IMLN metastases were identified in the breast specimens, it
has been suggested that complete ALND may be based on the axillary SLN negative status and thus, ALND
[9]
can be avoided in this setting . Even though our case has not demonstrated malignancy at the surgical
site, ECE is considered a sign of worse prognosis, and might be the evidence that leads us to the AR of this
patient. Moreover, there is not any standard definition of ECE in the literature. Some authors have used “focal”
[10]
or “extended” definition with no description regarding adjacent sites of invasion eventually . Standard
[11]
definition of ECE must be identified, because the ECE might be considered by future staging systems .
However, it’s impossible to conclude that IMLNs metastases featuring ECE might be an independent
outcome factor and its clinical meaning is yet controversial and unknown.

DECLARATIONS
Authors’ contributions
Sample collection: De Alcantara Filho PR, Bezerra SM
Analysis of medical aspects of research, data analysis: De Alcantara Filho PR

Availability of data and materials
All the data in this article is available to the readers.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Patient consented to participate in a research study.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Pugliese MS, Stempel MM, Cody HS 3rd, Morrow M, Gemignani ML. Surgical management of the axilla: do intramammary nodes matter?
Am J Surg 2009;198:532-7.
2. De Alcantara Filho PR, Curi C, Guatelli CS, Osorio CABT, Bezerra SM, et al. Intramammary sentinel lymph node with capsular
extravasation in breast cancer. Ann Surg Treat Res 2017;92:376-9.
3. Lee SK, Kim S, Choi MY, Kim J, Lee J, et al. The clinical meaning of intramammary lymph nodes. Oncology 2013;84:1-5.
4. Bolster MJ, Pepels MJ, Wauters CA, Schapers RF, Meijer JW, et al. Is the sentinel lymph node pathology protocol in breast cancer patients
associated with the risk of regional recurrence? Eur J Surg Oncol 2013;39:437-41.
5. Houvenaeghel G, Classe JM, Garbay JR, Giard S, Cohen M, et al. Survival impact and predictive factors of axillary recurrence after sentinel
biopsy. Eur J Cancer 2016;58:73-82.
6. Mamounas EP. NSABP breast cancer clinical trials: recent results and future directions. Clin Med Res 2003;1:309-26.
7. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, et al. Radiotherapy or surgery of the axilla after a positive sentinel
node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol
2014;15:1303-10.