Yoon Kwang Hyun, Lim Sung Mook, Koo Bonyong, Kim Jee Ye, Park Hyung Seok, Park Seho, Kim Seung Il, Park Byeong-Woo, Cho Young Up
Department of Surgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
Department of Surgery, Gangseo MizMedi Hospital, Seoul, Republic of Korea.
Gland Surg. 2020 Jun;9(3):629-636. doi: 10.21037/gs.2020.03.29.
Postoperative lymphedema in breast cancer survivors is a serious complication that develops from axillary lymph node dissection (ALND), chemotherapy, and radiation therapy. Axillary reverse mapping (ARM) was recently introduced to reduce lymphedema. This pilot study aimed to investigate the feasibility of preserving the ARM node using fluorescence imaging for patients at high risk of lymphedema.
We prospectively screened patients with breast cancer who had pathologic node-positive disease at diagnosis and were scheduled for neoadjuvant chemotherapy (NCT). The sentinel lymph node (SLN) was identified using blue dye and radioisotope, while the ARM node was traced using indocyanine green (ICG). In cases in which SLN was negative on the intraoperative frozen section examination, the ARM node and lymphatics were preserved.
Of the 20 screened patients, six whose metastatic axillary lymph node (ALN) was converted to clinically node-negative disease after NCT were enrolled. No patients experienced recurrence at 24 months postoperative. Four patients who had a preserved ARM node did not develop lymphedema. One patient whose ARM node was not preserved due to SLN identification failure did not develop postoperative lymphedema. One patient who underwent ALND without ARM node conservation because of metastatic SLN on frozen section examination developed postoperative lymphedema.
ARM is oncologically safe, decreases the incidence of postoperative lymphedema, and allows for the early detection of postoperative lymphedema in patients who underwent ALND. Ultimately, ARM may help improve the quality of life of patients with pathologic node-positive breast cancer.
乳腺癌幸存者术后淋巴水肿是一种严重的并发症，由腋窝淋巴结清扫术（ALND）、化疗和放疗引起。最近引入了腋窝反向映射（ARM）以减少淋巴水肿。这项前瞻性研究旨在探讨使用荧光成像为淋巴水肿高危患者保留ARM淋巴结的可行性。
我们前瞻性地筛选了诊断为病理淋巴结阳性疾病且计划接受新辅助化疗（NCT）的乳腺癌患者。使用蓝色染料和放射性同位素识别前哨淋巴结（SLN），同时使用吲哚菁绿（ICG）追踪ARM淋巴结。术中冰冻切片检查显示SLN为阴性的病例，保留ARM淋巴结和淋巴管。
在20例筛选患者中，6例在NCT后转移性腋窝淋巴结（ALN）转为临床淋巴结阴性疾病的患者入组。术后24个月无患者复发。4例保留ARM淋巴结的患者未发生淋巴水肿。1例因SLN识别失败未保留ARM淋巴结的患者未发生术后淋巴水肿。1例因冰冻切片检查发现转移性SLN而未保留ARM淋巴结接受ALND的患者发生了术后淋巴水肿。
ARM在肿瘤学上是安全的，可降低术后淋巴水肿的发生率，并能在接受ALND的患者中早期发现术后淋巴水肿。最终，ARM可能有助于改善病理淋巴结阳性乳腺癌患者的生活质量。
