Contralateral Lymph Node Visualization

Unusual Breast Cancer Relapse: When the Sentinel Node is on the Other Side

Lena Voss in Health & Wellness December 2025 • 4 min read.

"A Rare Case Study Highlights the Importance of Vigilance and Advanced Imaging in Breast Cancer Monitoring"

Breast cancer, while increasingly treatable, presents complex challenges, particularly in cases of recurrence. Standard treatment protocols involve surgery, chemotherapy, and radiation therapy, often guided by sentinel lymph node biopsy to assess the spread of cancer. Typically, the sentinel node examined is in the ipsilateral (same side) axilla (armpit).

However, unusual patterns of metastasis can occur. A fascinating case study published in "Surgery" in 2017 details a rare instance of breast cancer relapse where the contralateral axillary sentinel node (lymph node on the opposite side of the body from the original cancer) was involved. This highlights the critical need for vigilance and the use of advanced imaging techniques to detect atypical cancer spread.

This article dives into the specifics of this unusual case, what it means for breast cancer patients, and the implications for future monitoring and treatment strategies. Understanding these rare occurrences is essential for healthcare professionals and empowering for patients seeking comprehensive information about their condition.

The Case of the Contralateral Sentinel Node: A Detailed Look

In 2012, a 58-year-old woman was diagnosed with infiltrating ductal carcinoma, a common type of breast cancer. She underwent a lumpectomy, where the tumor was surgically removed, along with a selective sentinel node biopsy. Fortunately, the initial biopsy showed no signs of cancer spread, indicating that the cancer was localized. Following surgery, she received chemotherapy and adjuvant radiotherapy to eliminate any remaining cancer cells and reduce the risk of recurrence.

Despite the initial success, in 2015, a new periareolar mass (a lump near the nipple) was detected in the same breast. Core needle biopsy confirmed a local recurrence of invasive duct carcinoma. Further investigations, including chemotherapy, aimed to control the disease, but it was found that the cancer returned.

Lymphoscintigraphy: The patient underwent lymphoscintigraphy, a nuclear medicine procedure involving injecting a radioactive tracer near the tumor site. This tracer travels through the lymphatic system, highlighting the lymph nodes.
Unexpected Finding: The imaging revealed a startling discovery: the sentinel lymph node was located in the contralateral axilla (the opposite armpit). Typically, drainage occurs on the same side as the breast tumor.
Confirmation with SPECT/CT: Single-photon emission computed tomography/computed tomography (SPECT/CT) further confirmed the presence of three sentinel lymph nodes in the contralateral axilla.

This unusual pattern of lymphatic drainage suggested that the normal pathways had been disrupted, potentially due to the previous surgery or radiation therapy. Aberrant lymphatic drainage, as seen in this case, can occur when the usual channels are blocked or altered.

Implications for Breast Cancer Treatment and Monitoring

This rare case underscores the importance of individualized approaches to breast cancer treatment and the need for vigilant monitoring for recurrence. It highlights that cancer can behave unpredictably, and relying solely on typical patterns of spread can be misleading. Advanced imaging techniques, like lymphoscintigraphy and SPECT/CT, play a crucial role in identifying unusual lymphatic drainage and guiding treatment decisions. This case also emphasizes the importance of considering prior treatments, such as surgery and radiation, which can alter lymphatic pathways and influence the pattern of metastasis. For patients, understanding the potential for atypical recurrence patterns can empower them to advocate for comprehensive monitoring and personalized care. While such occurrences are rare, being aware of these possibilities ensures that healthcare teams remain vigilant in their approach to breast cancer management.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.surg.2017.07.005, Alternate LINK

Title: Visualization Of Contralateral Axillary Sentinel Node In A Patient With Breast Cancer Relapse And Prior Negative Sentinel Node

Subject: Surgery

Journal: Surgery

Publisher: Elsevier BV

Authors: Estefanía López-Rodríguez, Álvaro De Bonilla-Damiá, Rosa María Álvarez-Pérez, Jose Manuel Jiménez-Hoyuela García

Published: 2018-02-01

Everything You Need To Know

What is a contralateral axillary sentinel node and why is its involvement in breast cancer relapse considered unusual?

A contralateral axillary sentinel node refers to a lymph node in the armpit (axilla) on the opposite side of the body from the original breast cancer. Its involvement in relapse is unusual because the sentinel node biopsy typically examines lymph nodes on the same side (ipsilateral) of the body as the cancer. The case described shows that cancer can spread in unexpected ways, highlighting the importance of considering atypical patterns of metastasis and the need for comprehensive monitoring. This particular occurrence can be related to altered lymphatic pathways, possibly due to prior treatments such as surgery or radiation therapy, which can disrupt the normal drainage routes.

In the context of breast cancer treatment, what role does a sentinel lymph node biopsy play, and what does it help doctors determine?

A sentinel lymph node biopsy is a crucial procedure in breast cancer treatment. It helps doctors determine if the cancer has spread beyond the breast to nearby lymph nodes. The sentinel node is the first lymph node to which cancer cells are likely to spread. If the sentinel node is cancer-free, it suggests that the cancer has not spread to other lymph nodes, indicating a localized disease. This information guides treatment decisions, such as whether to proceed with further therapies like chemotherapy or radiation therapy. The case presented illustrates the importance of this procedure and the need to consider unusual patterns of cancer spread.

What specific advanced imaging techniques were employed in the case study to detect the unusual spread of cancer, and how do they work?

The case study utilized two advanced imaging techniques: lymphoscintigraphy and SPECT/CT. Lymphoscintigraphy involves injecting a radioactive tracer near the tumor site. This tracer travels through the lymphatic system, allowing doctors to visualize the lymph nodes. SPECT/CT (Single-photon emission computed tomography/computed tomography) combines SPECT, which provides detailed information about the function of organs and tissues, with CT (Computed Tomography), which provides detailed anatomical images. Together, they offer a comprehensive view of the lymphatic drainage pathways, helping to identify the location of the sentinel lymph nodes and any unusual patterns, such as the involvement of the contralateral axillary sentinel node.

How can prior treatments, such as surgery and radiation therapy, influence the pattern of metastasis in breast cancer cases?

Prior treatments, like surgery and radiation therapy, can alter the lymphatic pathways, influencing the pattern of metastasis. Surgery, such as lumpectomy, can disrupt the normal flow of the lymphatic system by removing lymph nodes or altering the surrounding tissues. Radiation therapy can damage or scar lymphatic vessels. These changes can lead to aberrant lymphatic drainage, meaning the cancer cells may spread through atypical routes. This disruption can result in the cancer spreading to lymph nodes in unexpected locations, as seen in the case of the contralateral axillary sentinel node. This emphasizes the importance of considering the patient's treatment history when monitoring for recurrence.

What are the key implications of this rare case for breast cancer patients and healthcare professionals regarding monitoring and treatment strategies?

This rare case highlights the need for individualized approaches to breast cancer treatment and vigilant monitoring for recurrence. For healthcare professionals, it underscores the importance of considering atypical patterns of metastasis and utilizing advanced imaging techniques like lymphoscintigraphy and SPECT/CT to detect unusual lymphatic drainage. It emphasizes the importance of considering a patient's prior treatments, such as surgery and radiation, which can alter lymphatic pathways. For patients, it's empowering to understand the potential for atypical recurrence patterns, encouraging them to advocate for comprehensive monitoring and personalized care. While rare, being aware of these possibilities ensures healthcare teams remain vigilant in breast cancer management, potentially improving patient outcomes through early detection and tailored interventions.