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OBJECTIVE: To explore the feasibility and safety of axillary reverse lymphatic mapping(ARM) afterneoadjuvant chemotherapy(NAC) for breast cancer.METHODS: The clinical data of 45 breast cancer patients whomreached yc N0 after being treated with NAC in the First Affiliated Hospital of Bengbu Medical College between January 2015 and July 2018 were analyzed retrospectively. Double tracer SLNB,directly ALND,or ALND followed by SLNBfailure/SLN + were performed according to the indication of the disease. All the patients were performed ARM usingmethylene blue dye during operation. The success rate of ARM mapping,tumor invasion rate and the safety of ARMlymph node retention were analyzed statistically.RESULTS: There were 13 patients in the ARM lymph node retentiongroup and 32 patients in the ARM lymph node resection group. Follow-up was up to June 2019,the median follow-uptime was 37.5(12-48)months. Discovery rate of ARM in ALND and SLNB group was 93.1%(27/29) and 40%(8/20)respectively. ARM lymph node and SLN overlap was 3 cases. ARM lymph node tumor metastasis was 1 case. Incidencerate of upper limb edema after surgery was lower in ARM reserved group than excision group(P=0.010). The differencesof local recurrence rate between ARM reserved group and excision group was not significant(P=1.000).CONCLUSION: For breast cancer patients with yc N0 after neoadjuvant therapy,reverse axillary lymph node mapping has a high successrate and a low tumor metastasis rate,which is safe and feasible.
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Lymphatic mapping has been performed in humans and dogs. Although several cases of anaphylaxis have been reported in humans, there are no such reports in dogs. The objective of this study was to identify the occurrence of adverse reactions to patent blue V dye in bitches undergoing uterine lymphatic mapping procedures using cardiovascular and hematological evaluations. The experiment was performed in 14 mongrel bitches without any reproductive disease, randomly assigned into two equal groups (PBV- uterine lynphatic mapping and OHE; Control - OHE only). The animals were submitted to pre- and postoperative hematological and serum biochemistry exams (7 days). The anesthetic protocol was: sedation (morphine and acepromazine), induction (propofol), maintenance (isoflurane), transoperative analgesia (fentanyl). Systolic blood pressure was monitored throughout the procedure and arterial blood gas analysis was performed immediate pre and postoperatively. For lymphatic mapping was injected patent blue V in the uterine wall, 10 minutes before OEH. Comparisons between the pre- and postoperative parameters within the same animal were performed using the Wilcoxon-Mann-Whitney test. To compare the values between control and PBV group was obtaining the difference between the pre and post of each group, subjected to the Mann-Whitney test (significance of 5%). Differences were observed (P<0.05) between the pre- and postoperative evaluations in the PBV (total protein and the albumin serum), in both groups (arterial partial pressure of oxygen) and in the Control (arterial oxygen saturation). There were no signs of adverse reactions to the patent blue V dye in the healthy bitches submitted to lymphatic uterine mapping.(AU)
O mapeamento linfático tem sido realizado em humanos e cães. Embora inúmeros casos de anafilaxia já tenham sido relatados em humanos, não existem tais relatos em cães. O objetivo deste estudo foi identificar a ocorrência de reações adversas ao corante azul patente V em cadelas submetidas ao mapeamento linfático uterino, usando avaliações cardiovasculares e hematológicas. O experimento foi realizado em 14 cadelas mestiças, divididas igualmente em dois grupos (PBV- mapeamento linfático uterino e OEH; Controle - apenas OEH). Os animais foram submetidos a exames hematológicos e bioquímicos séricos no pré e pós-operatório (7 dias). O protocolo anestésico foi: sedação (morfina e acepromazina), indução (propofol), manutenção (isoflurano), analgesia trans-operatória (fentanil). A pressão arterial sistólica foi monitorada durante todo o procedimento e hemogasometria arterial no pré e pós-operatório imediato. Para o mapeamento linfático foi injetado azul patente V na parede uterina, 10 minutos antes de realizar a OEH. Comparações entre os valores do pré e pós-operatório do mesmo animal foram realizados pelo teste Wilcoxon-Mann-Whitney. Para a comparação dos valores entre Controle e PBV foi realizado a obtenção da diferença entre os valores pré e pós de cada grupo, submetidas ao teste de Mann-Whitney (significância de 5%). Diferenças foram observadas (p<0,05) entre as avaliações pré e pós-operatórias no PBV (proteína total e albumina), ambos os grupos (pressão parcial de oxigênio arterial) e no Controle (saturação de oxigênio arterial). Não houve sinais de reação adversa ao corante azul patente V em cadelas saudáveis submetidas ao mapeamento linfático uterino.(AU)
Subject(s)
Animals , Female , Dogs , Anaphylaxis/veterinary , Coloring Agents , Lymph Nodes/pathology , Lymphatic Vessels/pathology , Reference Standards/analysis , Uterus/physiology , Staining and Labeling/veterinaryABSTRACT
Objective To evaluate the feasibility of upper limb lymph node conservation in axillary lymph node dissection(ALND)for early breast cancer patients.Methods This study involved 52 patients.Before ALND,they were,injected 5 ml of methylene blue subcutaneouly in ipsilateral upper limb for upper limb lymphatic mapping.Level II lymph nodes and upper limb lymph nodes were respectively separated from axillary lymph nodes during operation.Level II lymph nodes were given intraoperative imprint cytology and frozen section.All lymph nodes were given routine pathological examination after operation.Results Of the 52 patients,50 cases showed blue stained lymphatic vessels or lymph nodes in the axillary region.The rate of blue dye under naked eyes was 96.2%(50/52).The postoperative pathological examination showed there were 31 cases of axillary lymph nodes metastasis in patients with blue stained lymph nodes.There was 1 case with metastasis to level II lymph nodes only(2.0%)and 30 cases with metastasis to level I lymph nodes(60.0%).There were 10 cases with metastasis to both level II and level I lymph nodes(22.0%).There were 3 cases with metastasis to both level II and upper limb lymph nodes.3 patients with metastasis to upper limb lymph nodes all had metastasis to level II lymph nodes.For cases with metastasis to level I lymph nodes only,pathological examination showed there was no metastasis to the blue stained lymph nodes removed from the axillary region.For the ll cases with metastasis to level II lymph nodes,8 cases were successfully detected by intraoperative imprint cytology,9 cases were detected by frozen section and 10 were detected by the combination of imprint cytology and frozen section.Comparing the combining method(intraoperative imprint cytology and frozen section)and postoperative routine pathological examination,the concordant rate was 98.0%(49/50).Conclusions Subcutaneous methylene blue injection in ipsilateral upper limb call effectively map lymph nodes of upper limb in the axillary region.The upper limb lymph-node-conserving surgery in ALND can be performed if the patients don't have level II lymph node metastasis identified by intraop erative rapid pathological examination.
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Introducción: Un subgrupo de pacientes con carcinoma epidermoide cutáneo (CEC) tiene alto riesgo de presentar metástasis ganglionares regionales. El mapeo linfático y biopsia del ganglio centinela (MLBGC) ha sido exitosamente utilizado para evaluar la presencia de metástasis ganglionares subclínicas en diversos tumores. bjetivo: Evaluar la utilidad de la técnica del MLBGC en los pacientes con CEC de alto riesgo para detectar la presencia de metástasis ganglionares regionales subclínicas. Material y métodos: De enero 2002 a marzo 2004, un total de 20 pacientes con CEC de alto riesgo con ganglios linfáticos regionales clínicamente no palpables fue evaluado con linfografía preoperatoria y MLBGC. Resultados: En 1 de cada 5 pacientes (20 %), el ganglio centinela reveló la presencia de micrometástasis. Ningún paciente con GC negativo manifestó progresión tumoral ganglionar regional durante un seguimiento medio de 23.5 meses (rango de 7 a 44 meses). Conclusiones: El MLBGC fue técnicamente posible con baja morbilidad. El MLBGC puede tener un importante papel en el tratamiento de los pacientes con CEC de alto riesgo con ganglios linfáticos regionales no palpables. Esta técnica puede ayudar a identificar los pacientes con metástasis en los ganglios linfáticos regionales que pueden beneficiarse de una disección ganglionar radical. Además provee importante información para utilizar terapias adyuvantes a la cirugía.
BACKGROUND: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors. OBJECTIVE: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC. MATERIAL AND METHODS: Between January 2002 and March 2004, a total of 20 patients received pre-operative lymphoscintigraphy and sentinel lymphadenectomy for high-risk CSCC with clinically non-palpable regional lymph nodes. RESULTS: In one of each 5 patients (20%), sentinel lymph node showed histological evidence of microinvolvement. No patients with negative sentinel node showed tumor dissemination during follow-up, with a mean of 23.5 months (range 7-44). CONCLUSIONS: Sentinel lymph node biopsy is technically feasible with low morbidity. Sentinel lymphadenectomy may play an important role in the management of high-risk CSCC with clinically non-palpable regional lymph nodes. This technique can help identify patients with regional lymph node metastases who may benefit from complete lymphadenectomy. This improved staging may allow clinicians to better stratify patients who might benefit from adjuvant therapy.