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Ann Thorac Surg 1998;66:920-922
© 1998 The Society of Thoracic Surgeons

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Original articles: General Thoracic

Axillary lymph node metastases from bronchogenic carcinoma

^a Service de Chirurgie Thoracique, Hôpital Laennec, Paris, France
^b Laboratoire d’Anatomie Pathologique, Hôpital Laënnec, Paris, France

Accepted for publication April 7, 1998.

Address reprint requests to Dr Riquet, Service de Chirurgie Thoracique, Hôpital Laënnec, 42 rue de Sèvres, 75007 Paris, France

Background. Axillary lymph node metastases (ALNMs) from bronchogenic carcinoma are rare and their significance may be questioned. A surgical approach may allow a better understanding of the mechanism of their occurrence.

Methods. A retrospective study of 1,486 cases of surgically removed non–small cell lung carcinoma was performed. Twenty-two patients (1.5%) had extrathoracic nodal metastases. Nine of them were ALNMs (<1%). These cases form the basis of this study.

Results. In 1 patient ipsilateral ALNM was removed during a lung operation. It was a left non–small cell lung carcinoma invading the chest wall (T3 N2). In the other patients (n = 8) ALNMs were observed during postoperative follow-up; 4 underwent ALNM resection, 2 had radiotherapy, and 2 had symptomatic treatment only. For these 8 patients, in the TNM classification performed after an initial bronchogenic carcinoma operation, the lymph node status was, respectively, N0 in four cases, N1 in three cases, and N2 in one case. Survival ranged from 1 to 10 months, except for one patient who is still alive after more than 5 years. In this case, the ALNM was discovered 4 months after a right lower lobectomy for a T2 N0 adenocarcinoma.

Conclusions. Axillary lymph node metastases may be involved through direct chest wall invasion of bronchogenic carcinoma or retrograde spread from supraclavicular lymphnode block. However, another mechanism seems to be the systemic vascular route.

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