N_(1～3)期乳腺癌患者合并上肢淋巴结转移的临床研究

Clinical study of upper extremity lymph nodes metastasis in breast cancer patients staging pN_(1～3)

目的通过研究N1～3期乳腺癌患者上肢淋巴结转移情况,为腋窝淋巴结阳性患者在行腋窝淋巴结清扫术（ALND）中的上肢淋巴结保留术提供理论依据。方法 45例初诊伴有腋窝淋巴结转移的乳腺癌患者,以纳米碳混悬液行逆行腋窝淋巴结示踪术（ARM）,成功显影上肢淋巴结42例,对42例患者均行ALND（包括上肢淋巴结）,每例患者检出黑染的上肢淋巴结1～3粒,平均（2±0.9）粒;未黑染的腋窝淋巴结15～37粒,平均（26±6.9）粒。将所有检出淋巴结均送病检以了解上肢淋巴结转移情况及腋窝淋巴结分期情况。结果 N1期患者有26例,其中1例患者上肢淋巴结检出转移癌,N2期患者10例,其中2例上肢淋巴结检出转移癌,N3期患者有6例,其中5例上肢淋巴结检出转移癌。结论 N1～3期乳腺癌患者以纳米碳混悬液行ARM术是可行的,腋窝淋巴结转移癌可以同时合并上肢淋巴结转移,证明两者互有交通,因此N1～3期乳腺癌患者ALND时仅以腋窝淋巴结的病理分期来决定上肢淋巴结保留与否不严谨,需要寻找更加可靠的方法来评估上肢淋巴结保留术。

Objective Through the study of upper extremity lymph nodes metastasis in the patients with p N1～3breast cancer, to provide theoretical basis for the preserving upper extremity lymph nodes in positive axillary lymph nodes patients in axillary lymph nodes dissection（ALND）. Methods Forty-five newly diagnosed breast cancer patients with axillary lymph nodes metastasis were included. Using carbon nanoparticles suspension for axillary reverse mapping, 42 patients were labelled successfully and performed axillary lymph nodes dissection（included arm lymphtics）. 1～3 blue dye arm lymph nodes were checked out, and the average number was（2±0.9）. 15～37 not-dyed axillary lymph nodes were checked out, and the average number was（26±6.9）. Lymph nodes of the two groups were performed pathological section to study the statuses of the upper extremity lymph nodes metastasis and the stages of axillary lymph nodes. Results Twenty-six patients were graded as p N1, one of which was detected with upper extremity lymph nodes metastasis. Ten patients were graded as p N2, 2 of which were detected with upper extremity lymph nodes metastasis. Six patients were graded as p N3, 5 of which were detected with upper extremity lymph nodes metastasis.Conclusion It＇s feasible to use carbon nanoparticles suspension to carry out axillary reverse mapping during ALND for breast cancer patients staging p N1～3. Axillary lymph nodes metastasis might merge upper extremity lymph nodes metastasis, indicating the communications of the two. Accordingly, it＇s not rigorous to decide whether preserve the upper extremity lymph nodes during ALND by pathologic axillary lymph node staging for these patients only. It＇s required to search for more reliable methods to evaluate the axillary reverse mapping.