Published online Jun 26, 2025. doi: 10.12998/wjcc.v13.i18.103571
Revised: January 15, 2025
Accepted: January 24, 2025
Published online: June 26, 2025
Processing time: 82 Days and 18.9 Hours
Breast cancer is a leading cause of cancer-related mortality among women worldwide, with invasive ductal carcinoma (IDC) being the most prevalent subtype. Lymph node metastasis is the primary prognostic indicator, typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes. Contralateral axillary metastasis (CAM) without ipsilateral involvement is exceedingly rare, particularly in early-stage breast cancer. This report presents a case of CAM in a patient with triple-negative breast cancer (TNBC), underscoring diagnostic and therapeutic complexities.
A 73-year-old female presented with left-sided early-stage IDC in February 2023. Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes, a postoperative positron emission tomography (PET) scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla. Biopsy confirmed metastatic ductal carcinoma with triple-negative status, resulting in an upstaged diagnosis of metastatic breast cancer, stage IV, M1. The patient underwent six cycles of adjuvant chemotherapy, with follow-up PET imaging showing regression of the contralateral lesion. This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.
This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.
Core Tip: We present a 73-year-old female with triple-negative breast cancer (TNBC) exhibiting contralateral axillary lymph node metastasis without ipsilateral involvement. Despite early-stage diagnosis and modified radical mastectomy, positron emission tomography (PET) imaging and biopsy later upstaged the disease to metastatic stage IV. This case highlights the aggressive nature of TNBC, its complex lymphatic spread, the potential utility of PET scans for accurate staging in high-risk early breast cancers and treatment for contralateral axillary metastasis. These findings suggest reconsidering mandatory PET imaging for early TNBC or other high-risk cases to ensure accurate staging and optimal systemic therapy for improved outcomes.