Assistant Professor General Surgery, Zagazig University, 44519, Egypt.
Lecturer General Surgery, Zagazig University, 44519, Egypt.
Int J Surg. 2020 Mar;75:174-178. doi: 10.1016/j.ijsu.2020.01.152. Epub 2020 Feb 12.
Axillary lymph node dissection (ALND) is an important procedure for control of axillary nodal metastasis in breast cancer patients. Lymphedema, restriction of shoulder movement and axillary nodal recurrence are the most disabling complications of the procedure. Axillary reverse mapping (ARM) procedure for arm lymph node identification emerged as a step for their preservation during ALND. Here we are testing the effect of ARM on lymphedema development and whether it compromises oncological safety in early breast cancer patients.
98 clinically node free breast cancer female patients undergoing completion ALND after positive sentinel lymph node biopsy were recruited in the study. They were put into group A (49 patients with ARM + ve preservation ALND) and group B (49 patients in the conventional ALND group). ARM procedure was performed in both groups, ARM positive nodes were preserved in group A, marked and taken out with other axillary LN in group B. The outcome was histopathology of ARM + ve LN, development of arm lymphedema, and restriction of shoulder movement on follow-up.
ARM was positive in 46 patients (93.8%) in group A and 43 patients (87.8%) in group B, ARM + ve LN revealed positive metastasis only in 1 patient (2.3%) in group B. Lymphedema developed in 3 (6.5% patients in group A and 9 patients (20.9%) in group B. Restriction of shoulder movement showed a non-significant difference between the two groups.
Axillary reverse mapping and preservation of arm lymphatics helped to decrease the lymphedema rate without compromising oncological safety in early breast cancer.
腋窝淋巴结清扫术（ALND）是控制乳腺癌患者腋窝淋巴结转移的重要手段。淋巴水肿、肩关节活动受限和腋窝淋巴结复发是该手术最常见的致残性并发症。腋窝反向绘图（ARM）技术用于识别手臂淋巴结，可在 ALND 中保护这些淋巴结。本研究旨在探讨 ARM 对淋巴水肿发展的影响及其对早期乳腺癌患者的肿瘤安全性的影响。
本研究共纳入 98 例临床腋窝淋巴结阴性的乳腺癌女性患者，这些患者均在经前哨淋巴结活检阳性后接受了完成性 ALND。患者被分为 A 组（49 例接受 ARM 阳性保留的 ALND）和 B 组（49 例接受常规 ALND 组）。两组均行 ARM 检查，ARM 阳性淋巴结在 A 组中被保留，在 B 组中标记并与其他腋窝淋巴结一起取出。研究终点为 ARM 阳性淋巴结的组织病理学、手臂淋巴水肿的发生以及随访时肩关节活动受限情况。
A 组中 46 例（93.8%）患者 ARM 阳性，B 组中 43 例（87.8%）患者 ARM 阳性，B 组中仅 1 例（2.3%）患者 ARM 阳性淋巴结显示阳性转移。A 组中有 3 例（6.5%）患者发生淋巴水肿，B 组中有 9 例（20.9%）患者发生淋巴水肿。两组间肩关节活动受限差异无统计学意义。
在早期乳腺癌中，腋窝反向绘图和保留手臂淋巴管有助于降低淋巴水肿发生率，同时不影响肿瘤安全性。
