Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.
Wuhan University Center for Pathology and Molecular Diagnostics, Wuhan, Hubei, People's Republic of China.
Ann Surg Oncol. 2019 Oct;26(11):3446-3454. doi: 10.1245/s10434-019-07569-4. Epub 2019 Jun 25.
Controversy in axillary reverse mapping in axillary lymph node dissection (ALND) possibly results from incomplete recognition of the arm lymphatic system (ALS) and its compromise to oncological safety. The iDEntification and Preservation of ARm lymphaTic system (DEPART) technique facilitates complete identification of ALS; therefore, its use may decrease the occurrence of arm lymphedema. This study aimed to examine the arm lymphedema rate, locoregional recurrence, and feasibility to perform DEPART in ALND.
Patients from February 2013 to October 2017 from two tertiary referral centers were randomly assigned to two groups. In the study group, indocyanine green and methylene blue (MB) were utilized to identify arm sentinel nodes, and 0.1 ml MB was injected into the arm sentinel nodes to reveal the subsequent-echelon nodes and lymphatics. Gross arm lymph nodes were examined by intraoperative partial frozen section and were removed if positive. Arm lymphedema, local recurrence, regional recurrence, and distant metastasis were recorded at different follow-up examinations.
Arm sentinel nodes were identified in 573 (83.2%) patients. Subsequent-echelon nodes and lymphatics were visualized in 558 (97.4%) patients. Metastatic arm nodes were identified in 38 (6.8%) patients. The arm lymphedema rate was 3.3% (18/543) in the study group versus 15.3% (99/648) in the control group (p < 0.001) after 37-month median follow-up. Regional recurrence showed no difference between the two groups (1.4% and 1.2%, respectively) (p = 0.392).
DEPART can benefit breast cancer patients who undergo ALND, reducing the arm lymphedema rate without adversely affecting the morbidity of regional recurrence.
腋窝淋巴结清扫术（ALND）中腋窝反向映射的争议可能源于对臂淋巴系统（ALS）及其对肿瘤安全性的影响认识不足。iDEntification and Preservation of ARm lymphaTic system（DEPART）技术有助于完全识别 ALS；因此，它的使用可能会降低手臂淋巴水肿的发生。本研究旨在探讨在 ALND 中应用 DEPART 技术的手臂淋巴水肿发生率、局部区域复发率和可行性。
2013 年 2 月至 2017 年 10 月，来自两个三级转诊中心的患者被随机分为两组。在研究组中，吲哚菁绿和亚甲蓝（MB）用于识别手臂前哨淋巴结，并在手臂前哨淋巴结中注射 0.1mlMB 以显示后续级别的淋巴结和淋巴管。术中部分冷冻切片检查发现的粗大手臂淋巴结，并在阳性时切除。在不同的随访检查中记录手臂淋巴水肿、局部复发、区域复发和远处转移的情况。
573 例（83.2%）患者识别出手臂前哨淋巴结，558 例（97.4%）患者显示出后续级别的淋巴结和淋巴管。38 例（6.8%）患者识别出转移性手臂淋巴结。研究组中有 18 例（3.3%）患者发生手臂淋巴水肿，对照组中有 99 例（15.3%）患者发生手臂淋巴水肿（p<0.001），中位随访 37 个月后。两组之间的区域复发率没有差异（分别为 1.4%和 1.2%）（p=0.392）。
DEPART 可使接受 ALND 的乳腺癌患者受益，降低手臂淋巴水肿的发生率，而不会对区域复发的发病率产生不利影响。
