Department of Breast and Plastic Surgery, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
Gustave Roussy, Université Paris-Saclay, USM AMMICa, Plateforme Imagerie et Cytométrie, Villejuif, France; Université Paris-Saclay, CEA, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale Multimodale Paris Saclay, 91401, Orsay, France.
Eur J Surg Oncol. 2022 Dec;48(12):2393-2400. doi: 10.1016/j.ejso.2022.07.004. Epub 2022 Jul 8.
Axillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement.
The study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts.
94.5% of patients had ARM nodes identified (95%CI = [88.4-98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis.
ARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement.
NCT02994225.
乳腺癌患者腋窝淋巴结清扫（ALND）存在潜在的副作用，包括上肢淋巴水肿。腋窝反向映射（ARM）是一种能够区分腋窝淋巴结区域上肢和乳房淋巴引流的技术。我们旨在评估在接受 ALND 的全乳切除术期间通过近红外（NIR）荧光成像进行的 ARM 节点识别，然后分析 ARM 节点受累的潜在预测因素。
这项研究纳入了 119 例诊断为浸润性乳腺癌且需要进行 ALND 的患者。在 109 例患者中使用吲哚菁绿染料进行 NIR 成像，以识别 ARM 节点及其对应的淋巴管。
94.5%的患者识别出 ARM 节点（95%CI = [88.4-98.0]）。ARM 节点位于 D 区的占 63.4%。整个队列中有 55%的患者腋窝淋巴结有转移，19.4%的患者 ARM 节点也有转移。有 2 例患者存在转移性 ARM 节点，但其余腋窝淋巴结无转移。未观察到严重不良事件。仅核分裂象数量与 ARM 节点转移显著相关。
当进行 ALND 时，NIR 荧光成像的 ARM 可以实时识别 ARM 节点，是一种可靠的技术。与 ARM 节点组织学诊断相比的临床数据显示，仅诊断性活检中的核分裂象数量是 ARM 节点受累的潜在预测因素。
NCT02994225。
