Nos Claude, Lesieur Benedicte, Clough Krishna B, Lecuru Fabrice
Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, Paris, France.
Ann Surg Oncol. 2007 Sep;14(9):2490-6. doi: 10.1245/s10434-007-9450-4. Epub 2007 Jun 5.
Despite the widespread use of the sentinel lymph node biopsy technique, many patients with invasive breast cancer still undergo an axillary lymph node dissection and are at risk of arm lymphedema. With the new awareness of lymphatic spread in the axillary nodes, it should be possible to define a new surgical approach between sentinel lymph node biopsy and complete axillary dissection, a procedure preserving specifically lymph nodes in relation to the arm.
Twenty-one patients with an operable breast cancer requiring an axillary dissection underwent surgery with an attempt to separate nodes related to the breast from specific nodes related to the arm. After an injection of blue dye in the arm, the surgeon performed the axillary dissection trying to identify blue nodes and ducts in order to preserve lymphatic arm drainage (LAD). If the blue nodes were located in the normal axillary dissection, they were removed separately.
In 15 of 21 patients (71%), blue nodes in relation with LAD were identified. In 10 (47%) patients, it was possible to dissect the LAD with the preservation lymphatic ducts. In 10 patients, the LAD nodes were removed: none of them contained metastases, despite the fact that the non-LAD axillary nodes contained metastases in 7 of 10 cases.
Identifying the LAD with blue dye injection in the arm is possible. A subsequent study can now begin to determine if this procedure is safe for patients and able to prevent lymphedema of the arm.
尽管前哨淋巴结活检技术已广泛应用，但许多浸润性乳腺癌患者仍需接受腋窝淋巴结清扫术，并有发生手臂淋巴水肿的风险。随着对腋窝淋巴结淋巴扩散的新认识，应该有可能在保乳前哨淋巴结活检和彻底腋窝清扫之间确定一种新的手术方法，即一种专门保留与手臂相关淋巴结的手术。
21例需要进行腋窝清扫的可手术乳腺癌患者接受了手术，试图将与乳房相关的淋巴结与与手臂相关的特定淋巴结分开。在手臂注射蓝色染料后，外科医生进行腋窝清扫，试图识别蓝色淋巴结和淋巴管，以保留手臂淋巴引流（LAD）。如果蓝色淋巴结位于正常腋窝清扫范围内，则将其单独切除。
21例患者中有15例（71%）识别出与LAD相关的蓝色淋巴结。10例（47%）患者能够在保留淋巴管的情况下解剖LAD。10例患者切除了LAD淋巴结：尽管10例中有7例非LAD腋窝淋巴结有转移，但这些LAD淋巴结均未发现转移。
通过在手臂注射蓝色染料识别LAD是可行的。现在可以开始后续研究，以确定该手术对患者是否安全，以及是否能够预防手臂淋巴水肿。
