Seroma Cytology in Breast Cancer: An Underappreciated Issue

Abstract

The presence of cancer cells in postoperative drain fluid has been ignored when achieving local disease control in breast cancer. We designed a prospective study to examine the drain cytology and demonstrated malignant cells in the drainage fluid from 4 of 68 cases, mostly independent of the axillary status. These findings highlight the danger regarding the overall objective of "disease-free local control" in breast cancer surgery.

Background: The presence of malignant cells in postoperative seroma has been ignored in current breast cancer treatment. We aimed to assess the presence of malignant seroma cytology and to evaluate its relationship with the known prognostic factors for breast cancer. Patients and Methods: The solution from irrigation of the operation field and postoperative drainage fluid from 68 patients were prospectively collected and examined for malignant cytology. The results were evaluated according to the tumor characteristics and patient demographics. Results: Malignant cytology was found in none of the intraoperative samples but was found in the postoperative samples from 4 patients. Of these 4 patients, 3 were free of axillary metastasis. None of the common risk factors for breast cancer was associated with the finding of malignant cytology. Conclusion: Malignant cells can be seen in the drainage fluids from breast cancer patients independent of any contamination occurring during surgery, even in those without axillary metastasis.