Adverse prognostic significance of infraclavicular lymph nodes detected byultrasonography in patients with locally advanced breast cancer

Background: Ultrasonography is increasingly used to evaluate the nodal stat us of breast cancer patients and specialized positioning permits assessment of the infraclavicular fossa. However, the incidence and significance of i nfraclavicular (level III) adenopathy detected sonographically in locally a dvanced boast cancer (LABC) has not been defined. Methods: The study population consisted of 146 LABC patients registered in a prospective trial of induction chemotherapy between 1991 and 1996. All pa tients underwent ultrasound imaging before and after chemotherapy. Median f ollow-up was 32 months. Results: Forty-two of 146 patients (29%) had suspicious infraclavicular ade nopathy; all 42 had additional positive axillary lymph nodes by ultrasound. Disease-free and overall survival for the patients with suspicious infracl avicular adenopathy was significantly worse compared with patients without this feature; disease-free survival 50% versus 68% (P = 0.112); overall sur vival 58% versus 83% (P = 0.026). Conclusions: Nearly one third of LABC patients will have infraclavicular ly mph node involvement by ultrasound imaging; this finding is a significant a dverse prognostic feature, and we recommend that infraclavicular nodal eval uation become a routine component of the sonographic workup of breast cance r patients, particularly if lower axillary lymph nodes appear involved. (C) 2001 Excerpta Medica, Inc. All rights reserved.