Successful Management of Metastatic Lymph Nodes in the Chest by Laser Ablation via Endoscopic Ultrasound: A Case Report

Isolated spread of metastatic breast carcinoma to mediastinal lymph nodes is not an uncommon phenomenon. The prognosis worsens with the advent of any metastases in the chest. Conventional treatment mandates chemotherapy or radiotherapy as a control measures. Laser treatment has helped many patients with inaccessible or inoperable tumours, as it works on devascularisation and can benefit both benign and malignant tumours. This is a case report of a patient who did not respond to Trastuzumab and T-DM1 (Trastuzumab with Emtansine). She developed mediastinal lymph nodes during treatment with TDM1. Additionally, she had a documented change in hormonal status from Human Epidermal growth factor Receptor-2 (HER2) positive to negative. She underwent laser ablation of mediastinal lymph nodes around the trachea. A Positron Emission Tomography (PET) scan after six months showed a total resolution of the lymph nodes with no significant uptake in the chest or any other part of the body. Laser ablation of mediastinal lymph nodes is a very skillful and demanding procedure that can be attempted in refractory and isolated cases where chemotherapy and radiation have failed. Further studies are needed to assess the long-term results of this new procedure.