腋窝逆向淋巴结示踪术在乳腺癌患者选择性腋窝淋巴结清扫中的应用

Clinical application of axillary reverse mapping in breast cancer patients undergoing axillary lymph node dissection

目的探讨乳腺癌患者行选择性腋窝淋巴结清扫术时,通过施行腋窝逆向淋巴结示踪术(ARM)来保留引流上肢淋巴液的淋巴结的可行性。方法根据纳入、排除标准,选取南京医科大学第一附属医院乳腺外科2015年4—7月拟行腋窝淋巴结清扫术的80例女性乳腺癌患者进行前瞻性研究。用纳米炭混悬液行ARM,以胸背血管和腋静脉为界,将腋窝淋巴结分为3区:腋静脉上方区、胸背血管外侧区、胸背血管内侧区。通过病理分析淋巴结有无转移。结果 80例患者中,72例(90%)患者可显示黑染淋巴结,40例患者有腋窝淋巴结转移。在40例腋窝淋巴结转移患者中,纳米炭混悬液注射距手术开始时间<6 h的N_1和N_2期患者共14例,腋静脉上方淋巴结转移率为0/8,胸背血管外侧淋巴结转移率为0/11,胸背血管内侧转移率为5/11;而注射时间≥6 h的N_1、N_2期患者共15例,腋静脉上方淋巴结转移率为0/6,胸背血管外侧淋巴结转移率为3/11,胸背血管内侧转移率为7/11。在胸背血管外侧和腋静脉上方,引流上肢淋巴液的淋巴结转移率很低。结论 N_1、N_2期乳腺癌患者术前6 h内用纳米炭混悬液行ARM,胸背血管外侧和腋静脉上方淋巴结予以保留的价值可能较大。

Objective To explore the feasibility of axillary reverse mapping （ARM） in axillary lymph node dissection （ALND） for breast cancer patients in order to preserve the lymph nodes with lymphatic drainage in upper extremities. Methods A total of 80 breast cancer patients who were to receive ALND in the First Affiliated Hospital of Nanjing Medical University from April 2015 to July 2015 were enrolled in this perspective study according to the inclusion and exclusion criteria. Carbon nanoparticle suspension was used for ARM procedure. Axillary lymph nodes were categorized to three regions based on their locations to the axillary vein and thoracodorsal vessel： the region above axillary vein, the lateral region of thoracodorsal vessel and the medial region of thoracodorsal vessel. All the lymph nodes were dissected and pathologically detected whether lymph node metastasis existed. Results Black dyed lymph nodes were identified in 72 out of 80 patients （90%） and axillary lymph node metastasis was observed in 40 patients. In 40 patients with axillary lymph node metastasis, 14 in N1-2 stage patients had an interval between tracer injection and surgery〈6 h; among them, the lymph node metastasis rate was 0/8 in the region above axillary vein, 0/11 in the lateral region of thoracodorsal vessel and 5/11 in the medial region of thoracodorsal vessel. There were 15 patients in N1-2 stage with an interval between tracer injection and surgei7 i〉6 h; among them, the lymph node metastasis rate was 0/6 in the region above axillary vein, 3/11 in tile lateral region of thoracodorsal vessel and 7/11 in the medial region of thoracodorsal vessel. In the region lateral to thoracodorsal vessel and above axillary vein, the metastasis rate of lymph nodes with lymphatic drainage in the upper extremities was low. Conclusion If ARM using carbon nanoparticle suspension is performed within 6 h before axillary lymph node dissection in N1-2 stage breast cancer patients, lymph nodes in the region lateral to thoracodorsal vessel and above axillary vein may be preserved.