Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Radiat Oncol. 2019 Sep 2;14(1):159. doi: 10.1186/s13014-019-1367-0.
This study aimed to evaluate the impact of previous local treatment on lymphatic drainage patterns in ipsilateral breast tumor recurrence (IBTR) based on our data on re-operative sentinel lymph node biopsy (re-SLNB) for IBTR.
Between April 2005 and December 2016, re-SLNB using lymphoscintigraphy with Tc-99 m phytate was performed in 136 patients with cN0 IBTR. Patients were categorized into two groups: the AX group included 55 patients with previous axillary lymph node dissection; the non-AX group included 69 patients with previous SLNB and 12 patients with no axillary surgery. The whole breast irradiation (RT) after initial surgery had performed in 17 patients in the AX group and 27 patients in the non-AX group.
Lymphatic drainage was visualized in 80% of the AX group and 95% of the non-AX group (P < 0.01). The visualization rate of lymphatic drainage was associated with the number of removed lymph nodes in prior surgery. In the non-AX group, lymphatic drainage was visualized in 96% of patients without RT and 93% with RT. Lymphatic drainage was observed at the ipsilateral axilla in 98% of patients without RT and in 64% with RT (P < 0.0001). Aberrant drainage was significantly more common in patients with RT than without RT (60% vs. 19%, P < 0.001); it was observed mostly to the contralateral axilla (52% vs. 2%, P < 0.0001). In the AX group, patients with previous RT showed decreased lymphatic drainage to the ipsilateral axilla compared to those without RT (29% vs. 63%, P < 0.05) and increased aberrant drainage to the contralateral axilla (64% vs. 5%, P < 0.0001).
Lymphatic drainage patterns altered in re-SLNB in patients with IBTR and previous ALND and RT were associated with alterations in lymphatic drainage patterns.
本研究旨在通过对同侧乳腺肿瘤复发（IBTR）患者再次前哨淋巴结活检（re-SLNB）的研究数据，评估既往局部治疗对同侧腋窝淋巴结复发患者淋巴引流模式的影响。
2005 年 4 月至 2016 年 12 月，对 136 例 cN0 IBTR 患者进行了使用 Tc-99m 植酸钠淋巴闪烁显像的 re-SLNB。患者分为两组：AX 组包括 55 例曾行腋窝淋巴结清扫术的患者；非 AX 组包括 69 例曾行 SLNB 及 12 例未行腋窝手术的患者。AX 组 17 例及非 AX 组 27 例患者在初始手术后行全乳放疗（RT）。
AX 组和非 AX 组淋巴显像率分别为 80%和 95%（P<0.01）。淋巴引流的显像率与既往手术中切除的淋巴结数量有关。在非 AX 组中，未行 RT 的患者和行 RT 的患者的淋巴引流显像率分别为 96%和 93%。未行 RT 的患者中，89%的患者同侧腋窝可见淋巴引流，而行 RT 的患者中，仅 64%可见（P<0.0001）。有 RT 的患者异常引流明显多于无 RT 的患者（60%比 19%，P<0.001），且多向对侧腋窝引流（52%比 2%，P<0.0001）。AX 组中，与未行 RT 的患者相比，既往行 RT 的患者同侧腋窝淋巴引流减少（29%比 63%，P<0.05），而对侧腋窝异常引流增加（64%比 5%，P<0.0001）。
同侧乳腺肿瘤复发且有既往 ALND 和 RT 的患者在 re-SLNB 中，淋巴引流模式发生改变，与淋巴引流模式的改变有关。
