临床腋窝淋巴结阴性乳腺癌患者的腋窝逆行映射淋巴结受累情况。
The involvement of axillary reverse mapping nodes in patients with clinically node-negative breast cancer.
机构信息
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Kahoku, Uchinada, Ishikawa, 920-0293, Japan.
Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Kahoku, Uchinada, Ishikawa, 920-0293, Japan.
出版信息
Breast Cancer. 2022 Mar;29(2):209-215. doi: 10.1007/s12282-021-01300-6. Epub 2021 Sep 30.
BACKGROUND
Axillary reverse mapping (ARM) was developed to preserve the lymphatic drainage from the upper arm during sentinel lymph-node (SLN) biopsy or axillary lymph-node dissection (ALND). However, the oncological safety of ARM has been controversial because of not infrequent involvement of ARM nodes.
METHODS
Patients with clinically negative nodes (cN0) underwent SLN biopsy and ARM. SLNs were identified using blue dye and radioisotope, and ARM nodes were traced using the fluorescent method. Patients with positive SLN underwent the standard ALND. After surgery, they were followed up for more than 3 years.
RESULTS
A total of 507 patients with cN0 breast cancer were enrolled between May 2009 and November 2017. SLNs were identified in 499 (98%) of 507 patients, and ARM nodes were identified in 159 (31%) patients in the SLN field. The crossover rate of SLN-ARM nodes was 28%. Among 95 patients with positive SLNs, 70 patients underwent conventional ALND. ARM nodes were identified in 65 (93%) of those patients in the ALND field. The mean number of removed ARM nodes was 7.2 (range 0-25) in patients who underwent the standard ALND. Although ARM nodes were involved in 18 of 65 patients, the involved ARM nodes were the same SLNs identified in 14 (78%) patients. Since SLN-ARM nodes should be removed, ARM nodes were involved only in 4 (5.7%) patients after SLN biopsy.
CONCLUSIONS
Except for positive SLN-ARM nodes, the involvement of ARM nodes is infrequent in patients with positive SLN.
背景
腋窝反向绘图（ARM）旨在在进行前哨淋巴结活检或腋窝淋巴结清扫术（ALND）时保留上臂的淋巴引流。然而，由于 ARM 淋巴结的频繁受累，ARM 的肿瘤学安全性一直存在争议。
方法
临床阴性淋巴结（cN0）的患者接受 SLN 活检和 ARM。使用蓝色染料和放射性同位素识别 SLN，并使用荧光法追踪 ARM 淋巴结。SLN 阳性的患者接受标准 ALND。手术后，对他们进行了超过 3 年的随访。
结果
2009 年 5 月至 2017 年 11 月期间共纳入 507 例 cN0 乳腺癌患者。在 507 例患者中，499 例（98%）识别出 SLN，159 例（31%）患者在 SLN 区域识别出 ARM 淋巴结。SLN-ARM 淋巴结的交叉率为 28%。在 95 例 SLN 阳性的患者中，70 例行常规 ALND。在 ALND 区域中，在这些患者中识别出 65 例（93%）ARM 淋巴结。接受标准 ALND 的患者中移除的 ARM 淋巴结平均数量为 7.2 个（范围 0-25）。尽管在 65 例患者中有 18 例 ARM 淋巴结受累，但受累的 ARM 淋巴结与在 14 例（78%）患者中识别出的相同 SLN 相同。由于应该切除 SLN-ARM 淋巴结，因此在 SLN 活检后，仅在 4 例（5.7%）患者中 ARM 淋巴结受累。
结论
除了阳性的 SLN-ARM 淋巴结外，阳性 SLN 患者中 ARM 淋巴结受累的情况并不常见。
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