Puthangot Aswin, Chintamani Chintamani, Tandon Megha
Department of General Surgery, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, IND.
Cureus. 2023 Sep 14;15(9):e45267. doi: 10.7759/cureus.45267. eCollection 2023 Sep.
Introduction Sentinel lymph node biopsy (SLNB) has replaced routine axillary lymph node dissection (ALND) in node-negative axillae. In cases where the axilla needs to be dissected, one must dissect below the uppermost intercostobrachial nerve (ICBN) to avoid damaging arm lymphatics. Methods One milliliter of methylene blue dye was injected around the areola. Fluorescein dye (1 ml) was injected into the upper arm. After SLNB and ALND, the axilla was visualized under blue light. The location of fluorescent lymphatics was mapped with respect to the uppermost ICBN. Results The identification rate of sentinel lymph nodes and arm lymphatics was 100%. Arm lymphatics were above ICBN in 86.7%. The false negative rate of SLNB was 13%, with sensitivity and specificity of 87% and 100%, respectively. Conclusions SLNB using the single-dye technique has results comparable to dual agent studies that utilize blue dye and radioactive colloid. The uppermost ICBN could define the superior limit of axillary dissection.
引言 前哨淋巴结活检（SLNB）已取代了腋窝淋巴结阴性患者的常规腋窝淋巴结清扫术（ALND）。在需要进行腋窝清扫的病例中，必须在最上方的肋间臂神经（ICBN）下方进行清扫，以避免损伤臂部淋巴管。方法 在乳晕周围注射1毫升亚甲蓝染料。将1毫升荧光素染料注入上臂。在进行SLNB和ALND后，在蓝光下观察腋窝。相对于最上方的ICBN绘制荧光淋巴管的位置。结果 前哨淋巴结和臂部淋巴管的识别率为100%。86.7%的臂部淋巴管位于ICBN上方。SLNB的假阴性率为13%，敏感性和特异性分别为87%和100%。结论 使用单染料技术的SLNB结果与使用蓝色染料和放射性胶体的双剂研究相当。最上方的ICBN可确定腋窝清扫的上界。
