乳腺癌腋窝逆向淋巴作图的肿瘤安全性研究

Is axillary reverse mapping in patients with breast cancer oncologically safe?

目的研究乳腺癌腋窝逆向淋巴作图(axillary reverse mapping, ARM)的肿瘤安全性。方法前瞻性入组2015年10月至2016年2月于北京大学人民医院乳腺中心接受前哨淋巴结活检(sentinel lymph node biopsy, SLNB)或腋窝淋巴结清扫术(axillary lymphnode dissection, ALND)的患者,用核素法行ARM,从手术切除的淋巴结标本中分离出ARM淋巴结,并记录ARM淋巴结转移情况,分析ARM淋巴结转移的相关因素。结果共入组78例患者行78侧腋窝手术。53例SLNB中33例(62.3%)取到ARM淋巴结,22例(41.5%)取到的ARM淋巴结与前哨淋巴结有重合,1例(4.5%)SLN-ARM重合淋巴结可见癌转移。36例ALND中有33例(91.7%)可以检出ARM淋巴结,其中9例(25%) ARM淋巴结可见癌转移。腋窝淋巴结转移数目与ARM淋巴结阳性率存在正相关性(P二0. 036).结论SLNB活检术中应用ARM技术是安全有效的,可以减少淋巴水肿的发生。

Objective To evaluate the oncological safety of axillary reverse mapping in patients with breast cancer. Methods Patients with sentinel lymph node biopsy(SLNB) or axillary lymphnode dissection (ALND) between Oct 2015 and Feb 2016 were enrolled in this study prospectively. Axillary reverse mapping (ARM ) procedure was done using a radioisotope before the surgery. All the ARM nodes were identified and sent separately for histologic analysis. Results 78 patients underwent 78 axillary operations. Of 53 patients with SLNB, 33(62. 3%)had ARM nodes identified. 22(41. 5%)had the crossover of the ARM nodes with the SLNs, and one (4. 5%) had positive ARM node. Of 36 patients with ALND, 33 (91. 7%) had ARM nodes identified. 9(25%) had positive ARM nodes. Positive ARM node status was significantly associated with advanced axillary disease (P = 0. 036). Conclusion Preserving ARM nodes in SLNB is oncologically safe to reduce upper extremity lymphedema.