Isolated supraclavicular lymph node recurrence 1 year after breast-conserving therapy and negative sentinel lymph node biopsy for ductal carcinoma in situ

A rare case of a woman who presented with an isolated supraclavicular lymph node metastasis 1 year after initial surgery for breast cancer is described. The patient was a 47-year-old woman diagnosed with ductal carcinoma in situ (DCIS) of her left breast under stereo-guided, vacuum-assisted biopsy; she underwent lumpectomy and sentinel lymph node biopsy. The pathological diagnosis was DCIS, 15 × 15 × 33 mm, nuclear grade (NG) 1, estrogen receptor (ER)- and progesterone receptor (PgR)-positive, and surgical margin-negative. The sentinel lymph node was negative for cancer metastasis. She received radiotherapy but no other adjuvant therapy. A supraclavicular lymph node was detected on ultrasonography 1 year after lumpectomy and sentinel node biopsy. A PET scan was performed to rule out metastasis from an organ other than the breast. There was no accumulation except for the supraclavicular lymph node. Excisional biopsy was performed, showing lymph node metastasis from the breast. It was ER-positive, PgR-positive, human epidermal growth factor receptor (Her) 2-negative, and Ki67 80 %. She received radiation to the supraclavicular region and anti-estrogen therapy after the biopsy. Isolated supraclavicular lymph node metastasis was diagnosed only 1 year after initial breast surgery. The key issue was to ensure correct diagnosis in order to provide appropriate treatment, because the metastasis occurred early and was an isolated supraclavicular lymph node metastasis, which might have spread from an organ other than the breast.