Abbas Yara, Hamdy Omar
Mansoura Manchester Medical Program, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt.
Breast Dis. 2023;42(1):137-146. doi: 10.3233/BD-220040.
Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions.Although axillary dissection was a fundamental component of operative management, sentinel biopsy is an actual process for axillary staging. Axillary dissection may be postponed for cases that have negative SLNs or 1 or 2 infiltrated lymph nodes undergoing breast or axillary radiation. Contrarily, axillary dissection is still the conventional management for patients with clinically positive nodes.Arm lymphedema is a frequent and overwhelming complication of axillary dissection, with a worse impact on the patient's life.Axillary reverse mapping was recently introduced to map and conserve the lymph drain of the upper limb throughout axillary dissection or sentinel biopsy. A technique based on the theory that the breast's lymphatic drainage differs from those that drain the arm, so preserving lymphatic drainage of the upper limb can prevent lymphedema, thereby not raising the risk of axillary recurrence.Therefore, this technique is the reverse of sentinel biopsy, which remove the lymph nodes that drain the breast.
乳腺癌的标准手术管理已从广泛手术显著转向微创干预。尽管腋窝清扫术曾是手术管理的基本组成部分，但前哨淋巴结活检是目前腋窝分期的实际方法。对于前哨淋巴结阴性或有1或2个浸润性淋巴结且正在接受乳腺或腋窝放疗的病例，腋窝清扫术可推迟进行。相反，对于临床淋巴结阳性的患者，腋窝清扫术仍是传统的治疗方法。手臂淋巴水肿是腋窝清扫术常见且严重的并发症，对患者生活影响更大。腋窝反向映射技术最近被引入，以便在整个腋窝清扫术或前哨淋巴结活检过程中绘制并保留上肢的淋巴引流。该技术基于这样的理论，即乳腺的淋巴引流与上肢的淋巴引流不同，因此保留上肢的淋巴引流可预防淋巴水肿，从而不会增加腋窝复发的风险。因此，该技术与前哨淋巴结活检相反，前哨淋巴结活检是切除引流乳腺的淋巴结。
