For early stage breast cancer, the most common pattern of metastatic spread is to regional, ipsilateral draining lymph nodes. Identification and treatment of nodal disease with sentinel node mapping has resulted in a true paradigm shift in the staging and surgical management of early-stage breast cancer (15). For more advanced disease, breast cancer is readily capable of metastasizing to other organs of the body, with a particular prevalence for the bone, lung, liver, and brain. Autopsy studies of women dying of breast cancer reveal widespread disease involving the bones (70%), lungs (66%), liver (61%), and brain (30%) as the four most common metastatic sites (16-18). We will describe these patterns of locoregional and distant metastases below.
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