Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
World J Surg Oncol. 2012 Nov 1;10:233. doi: 10.1186/1477-7819-10-233.
BACKGROUND: Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphatic pathways during axillary lymph node dissection (ALND), thereby preventing lymphedema patients with breast cancer. However, the oncologic safety of sparing the nodes identified by ARM (ARM nodes), some of which are positive, has not been verified. We evaluated the metastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC) in assessing ARM node metastasis. METHODS: Sixty patients with breast cancer who underwent ARM during ALND between January 2010 and July 2012 were included in this study. Twenty-five patients were clinically node-positive and underwent ALND without sentinel lymph node biopsy (SLNB). Thirty-five patients were clinically node-negative but sentinel node-positive on the SLND. The lymphatic pathway was visualized using fluorescence imaging with indocyanine green. ARM nodes in ALND field, whose status was diagnosed using FNAC, were removed and processed for histology. We evaluated the correlation between the cytological findings of FNAC and the histological analysis of excised ARM nodes. RESULTS: The mean number of ARM nodes identified per patient was 1.6 ±0.9 in both groups. In most patients without (88%) and with (79%) SLNB, the ARM nodes were located between the axillary vein and the second intercostobrachial nerve. FNAC was performed for 45 ARM nodes, 10 of which could not be diagnosed. Six of the patients without SLNB (24%) and onewith SLNB (3%) had positive ARM nodes. Of these sevenpatients, four had >3 positive ARM nodes. There was no discordance between the cytological and histological diagnosis of ARM nodes status. CONCLUSIONS: Positive ARM nodes were observed in the patients not only with extensive nodal metastasis but also in those with a few positive nodes. FNAC for ARM nodes was helpful in assessing ARM nodes metastasis, which can be beneficial in sparing nodes essential for lymphatic drainage, thereby potentially reducing the incidence of lymphedema. However, the success of sampling rates needs to be improved.
背景：腋窝反向映射（ARM）是一种在腋窝淋巴结清扫术（ALND）期间保留上肢淋巴通路的新技术，从而预防乳腺癌患者出现淋巴水肿。然而，尚未证实通过 ARM 识别的节点（ARM 节点）的肿瘤学安全性，其中一些节点是阳性的。我们评估了 ARM 节点的转移状态以及细针抽吸细胞学（FNAC）在评估 ARM 节点转移中的作用。
方法：本研究纳入了 2010 年 1 月至 2012 年 7 月期间在 ALND 中进行 ARM 的 60 例乳腺癌患者。25 例患者临床淋巴结阳性，未行前哨淋巴结活检（SLNB）行 ALND；35 例患者临床淋巴结阴性，但 SLNB 前哨淋巴结阳性。使用吲哚菁绿荧光成像观察淋巴管通路。在 ALND 野中通过 FNAC 诊断 ARM 节点的状态，然后切除并进行组织学处理。我们评估了 FNAC 的细胞学结果与切除的 ARM 节点的组织学分析之间的相关性。
结果：两组患者平均每人识别的 ARM 节点数为 1.6±0.9。在大多数进行（88%）和未进行（79%）SLNB 的患者中，ARM 节点位于腋窝静脉和第二肋间臂神经之间。对 45 个 ARM 节点进行了 FNAC，其中 10 个无法诊断。6 例未行 SLNB 的患者（24%）和 1 例行 SLNB 的患者（3%）有阳性 ARM 节点。这 7 例患者中有 4 例有>3 个阳性 ARM 节点。ARM 节点状态的细胞学和组织学诊断无差异。
结论：不仅在广泛淋巴结转移的患者中，而且在少数阳性淋巴结的患者中，都观察到了阳性 ARM 节点。FNAC 有助于评估 ARM 节点转移，这有助于保留对淋巴引流至关重要的节点，从而可能降低淋巴水肿的发生率。然而，采样率的成功率需要提高。
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