Fanning James E, Chung David K V, Reynolds Hayley M, Jayathungage Don Tharanga D, Suami Hiroo, Donohoe Kevin J, Singhal Dhruv
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
J Surg Oncol. 2025 Jan;131(1):47-53. doi: 10.1002/jso.27827. Epub 2024 Sep 24.
Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma.
Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups.
Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p < 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p < 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p < 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p < 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p < 0.001).
Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. Levels II and III axillary, epitrochlear, and brachial nodes are possible sites of metastatic disease that should be considered in patients with a prior ALND.
腋窝淋巴结清扫术（ALND）后，手臂的淋巴引流可能会发生改变。了解这些改变很重要，因为它们可能会改变复发性乳腺癌或上肢皮肤癌（包括黑色素瘤）的标准手术和放射治疗。
利用单一机构的平面和单光子发射计算机断层扫描/计算机断层扫描淋巴闪烁造影数据库，我们确定了2008年至2023年期间诊断为上肢皮肤黑色素瘤的患者，这些患者此前因癌症治疗接受了ALND，且未发生上肢癌症相关淋巴水肿。将ALND患者与在相同解剖部位出现皮肤黑色素瘤的对照患者进行匹配。比较两组的前哨淋巴结（SLN）。
在3628例上肢黑色素瘤皮肤患者中，934例符合纳入标准，包括22例ALND患者和912例对照患者。98%的对照患者和27%的ALND患者观察到I级腋窝SLN引流（p < 0.001）。3%的对照患者和27%的ALND患者观察到II级腋窝SLN引流（p < 0.001）。1%的对照患者和32%的ALND患者观察到III级腋窝SLN引流（p < 0.001）。分别在9%的对照患者和32%的ALND患者中观察到滑车上SLN引流（p < 0.046）。在4%的对照患者和23%的ALND患者中观察到臂部SLN引流（p < 0.001）。
与对照患者相比，先前接受过ALND的患者手臂之间在功能性淋巴引流方面存在明显变化。II级和III级腋窝、滑车上和臂部淋巴结是转移性疾病的可能部位，对于既往接受过ALND的患者应予以考虑。
