采用腋窝反向绘图技术筛查患淋巴水肿风险较高的乳腺癌患者。
Using the axillary reverse mapping technique to screen breast cancer patients with a high risk of lymphedema.
机构信息
Breast Center, Peking University People's Hospital, Beijing, China.
Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
出版信息
World J Surg Oncol. 2020 Jun 1;18(1):118. doi: 10.1186/s12957-020-01886-9.
BACKGROUND
Preventing breast cancer-related lymphedema (BCRL) by preserving upper lymphatic drainage is still controversial. Our study aimed to use the axillary reverse mapping (ARM) technique in patients who underwent axillary surgery to analyse the correlation between postoperative residual ARM nodes and the occurrence of lymphedema, select candidates at high risk of developing lymphedema, and analyse the oncologic safety of ARM nodes.
METHODS
Patients undergoing sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) from October 2015 to February 2016 at the Peking University People's Hospital Breast Center were prospectively recruited for the study. ARM was performed in all patients before surgery. ARM nodes were separated from SLNB and ALND specimens. Data were collected on the identification of ARM nodes before surgery, number of residual ARM nodes after surgery, nodal status, crossover rate, and correlation between residual ARM nodes and the occurrence of lymphedema.
RESULTS
The analysis included 78 patients. Of the 53 patients who underwent SLNB, crossover between ARM nodes and breast sentinel lymph nodes (SLNs) was seen in 22 specimens. The incidence of ARM node metastasis was 1.89% (1/53) and 25% (9/36) in the SLNB and ALND groups, respectively. The number of positive axillary lymph nodes was associated with the involvement of ARM nodes (P = 0.036). The incidence of residual ARM nodes was significantly higher in the SLNB group than in the ALND group (67.6% vs. 37.9%, P = 0.016). The incidence of lymphedema was significantly higher in the ALND group than in the SLNB group (33.3% vs. 5.4%, P = 0.003).
CONCLUSIONS
For SLNB, the ARM technique can help to resect SLNs more accurately. However, we do not recommend using the ARM technique to preserve ARM nodes in patients undergoing ALND due to oncologic safety issues. Nevertheless, we can predict patients undergoing axillary surgery who are more likely to have a high risk of lymphedema by assessing residual ARM nodes.
TRIAL REGISTRATION
This study was registered on ClinicalTrials.gov in February 2016. The clinical trial registration number is NCT02691624.
背景
通过保留上肢淋巴引流来预防乳腺癌相关性淋巴水肿（BCRL）仍存在争议。我们的研究旨在使用腋窝反向映射（ARM）技术对接受腋窝手术的患者进行分析，以探讨术后残余 ARM 淋巴结与淋巴水肿发生之间的相关性，选择高风险发生淋巴水肿的患者，并分析 ARM 淋巴结的肿瘤学安全性。
方法
本研究前瞻性地招募了 2015 年 10 月至 2016 年 2 月期间在北京大学人民医院乳腺中心接受前哨淋巴结活检（SLNB）或腋窝淋巴结清扫术（ALND）的患者。所有患者在术前均进行 ARM 检查。ARM 淋巴结与 SLNB 和 ALND 标本分开。收集术前 ARM 淋巴结的识别、术后残余 ARM 淋巴结数量、淋巴结状态、交叉率以及残余 ARM 淋巴结与淋巴水肿发生之间的相关性数据。
结果
分析共纳入 78 例患者。在 53 例行 SLNB 的患者中，22 例标本中 ARM 淋巴结与乳腺前哨淋巴结（SLN）交叉。SLNB 和 ALND 组 ARM 淋巴结转移率分别为 1.89%（1/53）和 25%（9/36）。阳性腋窝淋巴结数量与 ARM 淋巴结受累有关（P = 0.036）。SLNB 组残余 ARM 淋巴结的发生率明显高于 ALND 组（67.6% vs. 37.9%，P = 0.016）。ALND 组淋巴水肿的发生率明显高于 SLNB 组（33.3% vs. 5.4%，P = 0.003）。
结论
对于 SLNB，ARM 技术有助于更准确地切除 SLN。然而，由于肿瘤学安全性问题，我们不建议在接受 ALND 的患者中使用 ARM 技术来保留 ARM 淋巴结。然而，我们可以通过评估残余 ARM 淋巴结来预测接受腋窝手术的患者，这些患者更有可能发生淋巴水肿的高风险。
试验注册
本研究于 2016 年 2 月在 ClinicalTrials.gov 上注册。临床试验注册号为 NCT02691624。
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