Effect of breast endoscope and routine axillary lymph node dissection in breast conserving surgery for breast cancer / 中国综合临床

Objective:To explore the effect of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND) in breast conserving surgery for breast cancer.Methods:This study adopts a case-control study. We selected 40 female breast cancer patients who underwent MALND in Tangshan People's Hospital from July 2016 to August 2019 (observation group), and 40 female breast cancer patients who underwent CALND in the same period as the control group. The two groups of patients were operated by the same group of doctors. After tracheal intubation and general anesthesia, the patients underwent breast conserving surgery first. After the intraoperative frozen pathology showed that breast conserving was successful, the control group underwent MALND, and the observation group underwent breast endoscopic axillary lymph node dissection. The levels of blood biochemical indicators, inflammatory factors, stress response indicators, myocardial injury markers and tumor blood circulation micrometastasis indicators, the number of lymph node dissection, operation time, intraoperative bleeding, postoperative drainage, hospital stay, hospital expenses and other surgical observation indicators, as well as the incidence of postoperative complications were compared between the two groups 3 days after operation. The measurement data with normal distribution was expressed by xˉ± s, and the comparison between the two groups was conducted by independent sample t-test; The counting data was expressed in cases (%), and the χ 2 test or Fisher exact probability method was used for comparison between groups. Results:Three days after operation, the erythrocyte count and hemoglobin level in the observation group were lower than those in the control group ((4.03±0.57)×10 12/L vs (4.33±0.54)×10 12/L, (110.90±24.20) g/L vs (129.70±14.90) g/L), cTnI, creatine kinase and CK-MB levels were higher than those in the control group ((17.4±2.3) μg/L vs (13.1±1.8) μg/L, (178.1±35.4) U/L vs (133.1±45.1) U/L, (10.7±1.6) U/L vs (7.0±1.2) U/L), the operation time was longer than that of the control group ((89.4±15.6) min vs (69.6±13.8) min), the intraoperative bleeding volume and postoperative drainage volume were more than that of the control group ((69.5±6.4) mL vs (33.3±7.7) mL, (334.5±51.1) mL vs (236.8±44.3) mL), but the hospital stay was shorter than that of the control group ((7.1±3.1) d vs (15.5±4.7) d). The cost of hospitalization was lower than that of the control group ((13 689.7±1 204.2) yuan compared with (19 734.5±1 391.5) yuan), and the difference was statistically significant ( t values were 2.16, 3.71, -11.69, -4.68, -11.34, -6.01, -22.87, -9.14, 9.44, 20.78; all P<0.05). There was no statistically significant difference between the two groups in inflammatory factors, stress response indicators, cell adhesion factor levels, number of lymph node dissection and postoperative complications (all P>0.05). Conclusions:Compared with CALND, MALND for breast cancer patients will not cause serious inflammatory reaction and stress reaction, and will not increase the risk of tumor blood micrometastasis and the incidence of complications, but will cause some damage to myocardial cells. Lipolysis and liposuction during MALND can increase intraoperative bleeding volume and postoperative drainage volume, and prolong the operation time while improving the quality of the operation field, However, it has obvious advantages in shortening hospitalization time and reducing hospitalization expenses.

Identification and preservation of arm lymphatics in axillary lymph node dissection to prevent arm lymphedema: a single center randomized controlled trial / 中华肿瘤杂志

Objective: To evaluate the feasibility of identification and preservation of arm lymphatics (DEPART) in axillary lymph node dissection (ALND) for breast cancer to prevent arm lymphedema. Methods: A randomized controlled study method was used. Two hundred and sixty-five patients who underwent breast cancer surgery at the Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University from November 2017 to June 2018 were included, and the patients were randomly divided into ALND+ DEPART group (132 patients) and standard ALND group (133 patients) by random number table method. In the ALND+ DEPART group, indocyanine green and methylene blue were injected as tracers before surgery, and the arm sentinel nodes was visualized by staged tracing during intraoperative dissection of axillary lymph nodes. Partial frozen sections were made of arm lymph nodes >1 cm in length and hard and suspicious of metastasis, and arm lymph nodes and lymphatic vessels were selectively preserved. Patients in the standard ALND group underwent standard ALND. Objective and subjective indexes of arm lymphedema were evaluated by 5-point circumference measurement and Norman questionnaire. Results: Among 132 breast cancer patients in the ALND+ DEPART group, 121 (91.7%) completed DEPART. There were no statistically significant differences in age, body mass index, pathological type, dissection number of axillary lymph node, N stage, TNM stage, molecular typing, and regional radiotherapy between the ALND+ DEPART and standard ALND groups (P>0.05). At a median follow-up of 24 months, assessment by the 5-point circumference measurement showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.0% (6/121) and 15.8% (21/133), respectively, with statistically significant differences (P=0.005). Assessment by the Norman questionnaire showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.8% (7/121) and 21.8% (29/133), respectively, with a statistically significant difference (P<0.001). No local regional recurrence was observed in either group during the follow-up period. Conclusion: For breast cancer patients with positive axillary lymph nodes, the administration of DEPART during ALND can reduce or avoid the occurrence of arm lymphedema without compromising oncology safety.

Disección axilar dirigida utilizando carbón vegetal como marcador en paciente con cáncer de mama tratada con quimioterapia neoadyuvante. Técnica quirúrgica / Targeted axillary dissection using charcoal as a marker in a patient with breast cancer treated with neoadjuvant chemotherapy. Surgical technique

Describir la técnica quirúrgica de la disección axilar dirigida (DAD) usando carbón vegetal como marcador del ganglio linfático axilar metastásico al momento del diagnóstico conjuntamente con la biopsia del ganglio centinela en paciente con cáncer de mama tratada con quimioterapia neoadyuvante con respuesta completa clínica y ecográficamente, demostrando su seguridad y eficacia. Material y Métodos: Estudio retrospectivo y descriptivo. Paciente con cáncer de mama y ganglio linfático metastásico en axila ipsilateral marcado con carbón vegetal al confirmarse ese diagnóstico y tratada con quimioterapia neoadyuvante con posterior negativización tanto clínica como ecográfica del ganglio linfático metastásico. Se planificó para disección axilar dirigida (extirpación del ganglio marcado con carbón vegetal y biopsia de ganglio centinela) con el fin de demostrar la eficacia del marcador utilizado y su relación o no con el ganglio centinela. Resultados: Se comprobó la identificación certera del ganglio afectado marcado con carbón vegetal el cual no presentó migración del colorante o reacción inflamatoria local coincidiendo además con dos ganglios centinelas todos con respuesta patológica completa. El carbón permaneció 153 días desde su administración hasta la cirugía axilar. Conclusión: Esta experiencia admite el marcaje con carbón vegetal del ganglio axilar metastásico al momento de su diagnóstico como un método seguro, sencillo, económico y accesible en relación a otros métodos de marcaje, además su asociación con la biopsia del ganglio centinela nos permite prescindir de la disección axilar en caso de respuesta patológica completa, sin embargo, es importante resaltar que se necesitan evaluar más casos para obtener conclusiones determinantes(AU)

To describe the surgical technique of targeted axillary dissection using charcoal marking of the metastatic lymph node at the time of diagnosis together with sentinel node biopsy in a breast cancer patient who received neoadjuvant chemotherapy with complete clinical and sonographical response, demonstrating its safety and efficacy. Material and Methods: Retrospective and descriptive study. Patient with breast cancer and metastatic lymph node in the ipsilateral axilla which was marked with charcoal upon confirmation of this diagnosis and treated with neoadjuvant chemotherapy with subsequent clinical and sonographical negativization of the metastatic lymph node. It was planned for targeted axillary dissection (removal of charcoal-marked lymph node and sentinel node biopsy) in order to demonstrate the efficacy of the marker used and its relationship or not with the sentinel node. Results: The correct identification of the affected lymph node marked with charcoal was verified, which did not present dye migration or local inflammatory reaction, also coinciding with two sentinel nodes, all of them with a complete pathological response. The charcoal remained 153 days from its administration until the axillary surgery. Conclusion: This experience supports charcoal marking of the metastatic lymph node at the time of diagnosis as a safe, simple, inexpensive and accessible method in relation to other marking methods, in addition its association with sentinel node biopsy allows us to dispense with axillary dissection in case of complete pathological response, however it is important to highlight that more cases need to be evaluated to obtain decisive conclusions(AU)

Comparison of Baska Laryngeal Mask Airway and Endotracheal Tube in Adult Patients Undergoing Surgery under General Anesthesia: A Prospective Randomized Study

Background: Airway management is considered as an integral part of general anesthesia. Use of Baska mask, since asupraglottic airway device, could result in the low incidence of hemodynamic alterations and post-operative pharyngolaryngealcomplications. We conducted this study to compare the hemodynamic parameters, i.e., systolic blood pressure (SBP),diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), ease of insertion, time of insertion, and post-operativepharyngolaryngeal complications during Baska mask and endotracheal tube (ETT) insertion.Materials and Methods: It was a prospective randomized study which was conducted on 80 adult patients admitted for electivesurgery under general anesthesia (GA) of 60–90 min duration. A total of 80 patients were randomly allocated into two groups,i.e., Group B and Group E of 40 each. Group B patients underwent Baska mask insertion and Group E patients underwent ETTinsertion. The statistical analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: There was a statistically significant rise in SBP, diastolic blood pressure, MAP, and HR during ETT insertion as comparedto Baska mask insertion. The mean time of insertion of Baska mask was 12.8 ± 1.36 s and of ETT was 15.93 ± 1.51 s. Insertionof Baska mask was easy in 85% whereas insertion of ETT was easy in 65%.Conclusion: Baska mask can be used as an alternative to ETT in adult patients undergoing surgeries under GA of 60–90 minduration with minimal hemodynamic alterations and post-operative pharyngolaryngeal complications.

Research progress of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer / 国际外科学杂志

The feasibility and safety of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for breast cancer are still controversial in clinical practice. SLNB after NAC is feasible and safe for patients with clinically node-negative (cN0) breast cancer, while those with clinically node-positive (cN+ ) should be carefully considered. In addition to methylene blue and 99mTc-sulfur colloid tracing, some other tracing methods have been proposed in clinical studies, such as carbon nanoparticles and indocyanine green fluorescence tracing. The axillary lymph node (ALN) state of SLNB patients after NAC was associated with molecular subtyping, response to chemotherapy, residual breast tumor size, etc. Therefore, a number of factors should be considered to determine whether ALN dissection is needed. The false negative rate of SLNB after NAC can be reduced by some measures such as placing clips prior to surgery and preoperative tattooing with sterile black carbon suspension. Besides ALN, internal mammary lymph nodes is another route for breast cancer metastasis. As a low-invasive diagnostic technique, internal mammary sentinel lymph node biopsy can complete lymph node staging and pathological staging to guide treatment. This review attempts to introduce the research progress of SLNB after NAC from multiple aspects such as feasibility and safety, tracer methods, assessment of ALN status and methods to reduce false negative rate.

Research progress of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer / 国际外科学杂志

The feasibility and safety of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for breast cancer are still controversial in clinical practice.SLNB after NAC is feasible and safe for patients with clinically node-negative (cN0) breast cancer,while those with clinically node-positive (cN +) should be carefully considered.In addition to methylene blue and 99mTc-sulfur colloid tracing,some other tracing methods have been proposed in clinical studies,such as carbon nanoparticles and indocyanine green fluorescence tracing.The axillary lymph node (ALN) state of SLNB patients after NAC was associated with molecular subtyping,response to chemotherapy,residual breast tumor size,etc.Therefore,a number of factors should be considered to determine whether ALN dissection is needed.The false negative rate of SLNB after NAC can be reduced by some measures such as placing clips prior to surgery and preoperative tattooing with sterile black carbon suspension.Besides ALN,internal mammary lymph nodes is another route for breast cancer metastasis.As a low-invasive diagnostic technique,internal mammary sentinel lymph node biopsy can complete lymph node staging and pathological staging to guide treatment.This review attempts to introduce the research progress of SLNB after NAC from multiple aspects such as feasibility and safety,tracer methods,assessment of ALN status and methods to reduce false negative rate.

Role of Axillary Radiotherapy in Patients of Locally Advanced Carcinoma Breast with Inadequate or unknown Lymph Node Dissection Status - An Institutional Audit

Introduction: Loco-regional radiotherapy to supraclavicularand Axillary region has been the standard of care for treatmentof locally advanced carcinoma breast without or doubtfulaxillary clearance. We did a clinical audit of the patient careprovided and the outcome of the same relating to loco-regionalradiotherapy for such patients at a district medical college inIndia.Material and methods: All patients with locally advancedcarcinoma breast between 2007 and 2013 who had treatmentin the Department of Radiotherapy were audited. The patientswere stratified as per surgery they had and pathologicalinformation that was available in their post op HPE reportalong with type of radiotherapy they received. The analysiswas done with IBM SPSS V23.Results: over the period of 6 years there were 874 patientsof carcinoma breast registered in the Department. Out ofthem 246 were metastatic. 12 were early breast carcinomas,rest 616 were LABC who had indications of Supraclavicularand Axillary RT due to any reason. Out of these 616 patientsthe indication in 592 patients was lack of pathologicalinformation in terms of number of nodes dissected beinglesser than 10. 138 of them were referred from other centerswhere Radiotherapy was not available and therefore theyfollowed up at other centers. 77 patients never completed theirtreatment (radiotherapy or chemotherapy). Additionally 42patients never came for any follow up after their treatmentcompletion. A total of 359 analyzable patient records werefound who had at least one follow up.Conclusion: In our audit due to limited resources nearly 63%of the patients received RT only chest wall and supraclavicularregion RT. However it did not change the loco-regionalfailure rate at 5.3 years. A longer follow up data of 10 yearsis necessary to see whether this trend is continued to OS.However the present retrospective data provides a startingpoint for prospective clinical trials to look if certain groupof patients may benefit from omitting Axillary Radiotherapyeven when the dissection had yielded lesser than 10 nodes

Role of Axillary Reverse Mapping in Breast Cancer to Decrease Complications

Introduction: The concept of axillary reverse mapping (ARM) is to map this part of upper limb drainage. If lymphedema ofthe upper extremity is caused by removing lymphatics and nodes situated in the axilla, theoretically the ability to map theselymphatics would enable surgeons to preserve them.Aim: The aim of the study was to study the effect of ARM technique on the incidence of seroma and lymphedema after modifiedradical mastectomy (MRM).Materials and Methods: A prospective, randomized, and controlled study over 40 female patients who underwent MRM. Patientswere divided and randomized into study and control groups, 20 patients for each. In the study group, the ARM procedure wasdone by injecting 2.5 ml of methylene blue dye intradermally and subcutaneously in the upper inner ipsilateral arm along themedial intramuscular groove before axillary lymph node dissection. Operative and post-operative results were recorded.Results: ARM procedure and successful visualization of arm lymphatics were achieved in 17 patients (85%). Statistically,there was no significant difference between the two groups regarding patient and tumor characteristics, operative time anda number of excised lymph nodes. There was significant difference favoring the ARM group in decreasing the incidence ofseroma, lymphedema and time passed till remove drains.Conclusion: ARM procedure facilitated arm lymphatics visualization. It is an easy non-time-consuming procedure. It resulted in asignificant reduction in the incidence of seroma and lymphedema, with a considerable reduction in the overall complications rate.

Therapeutic effect of axillary lymph node dissection and local radiotherapy on patients with stage Ⅰ-Ⅱ sentinel lymph node-positive breast cancer / 国际外科学杂志

Objective To compare the recurrence rate and survival rate of axillary lymphadenectomy and axillary local radiotherapy after breast-conserving surgery in patients with stage Ⅰ-Ⅱ breast cancer who were positive for sentinel lymph node biopsy.Methods A retrospective analysis of 137 patients with stage Ⅰ-Ⅱ breast cancer who were positive for sentinel lymph node biopsy from January 2010 to July 2015 in Yulin First Hospital was performed.Patients underwent axillary lymph node dissection (ALND) after breast-conserving surgery were assigned to the ALND group (n =92),patients with axillary local radiotherapy (RNI) after breast-conserving surgery were assigned to the RNI group (n =45),and the general clinical characteristics (mean age,menopause,clinical stage,etc.) were compared between the two groups,and prognosis (2-year recurrence rate,distant metastasis rate,cumulative 2-year event-free survival,cumulative 2-year overall survival).Measurement data were expressed as ((x) ± s),and t test was used for comparison between groups;count data was expressed as rate (％),and chi-square test was used for comparison between groups.Results There were no statistical differences in general clinical characteristics (mean age,menopausal number,clinical stage,etc.) between the two groups.For patients with stage Ⅰ-Ⅱ sentinel lymph node-positive adenocarcinoma,breast-conserving surgery plus axillary lymph node dissection (ALND group) and breast-conserving 2-year recurrence rate (4.4％,6.7％,P =0.87)and distant metastasis rate (9.7％,15.6％,P =0.48) and cumulative 2 years of surgery plus axillary local radiotherapy (RNI group) There were no statistically significant differences in event-free survival (85.9％,75.6％,P =0.14) and cumulative 2-year overall survival (90.2％,86.7％,P =0.53).Conclusion For patients with stage Ⅰ-Ⅱ sentinel-positive breast cancer,axillary RNI may be a new treatment for ALND.

Accessory breast cancer:A case report and literature review / 吉林大学学报(医学版)

Objective:To analyze the clinical pathological features of one patient with accessory breast cancer (ABC),and to explore the diagnosis,treatment,operation methods and prognosis of ABC patient.Methods:The patient received right axillary tumor resection,right axillary accessory breast resection and axillary lymph node dissection,didn't receive resection of breast in the affected side.According to the intraoperative frozen pathological diagnosis,the clinical diagnosis was ABC.After operation,the patient was treated with 8 cycles of AC-T regimen adjuvant chemotherapy(The first four cycles were given pirarubicin 60 mg·m-2,cyclophosphamide 600 mg·m-2 per cycle;the last four cycles were given docetaxel 100 mg·m-2per cycle;every three weeks was a cycle of treatment),radiation therapy(The radiation dose was 50 Gy/25 f in the upper and lower part of the right collarbone and the tumor bed area,and after retract the tumor bed area was increased to 60 Gy)and endocrine therapy(Tamoxifen was administered at 20 mg per day).Results:The patient's breast color ultrasound and mammogram examination indicated that the right axillary mass of the patient was more likely to be malignant.The clinical diagnosis was right axillary ABC.According to the NCCN guide,the patient was treated with the standardized comprehensive treatment based on surgical treatment.16 months after operation,the patient recovered well and had a normal life.There was no upper limb dysfunction and no lateral upper limb lymphedema,and there were no recurrence or metastasis.Conclusion:ABC is extremely rarely seen in clinical practice.The clinical pathological features and treatment of ABC are similar to breast cancer.If there is no lesion in the mammary gland, it is not necessary to remove the mammary gland in the affected side.

Accessory breast cancer: A case report and literature review / 吉林大学学报(医学版)

Objective: To analyze the clinical pathological features of one patient with accessory breast cancer (ABC), and to explore the diagnosis, treatment, operation methods and prognosis of ABC patient. Methods: The patient received right axillary tumor resection, right axillary accessory breast resection and axillary lymph node dissection, didn't receive resection of breast in the affected side. According to the intraoperative frozen pathological diagnosis, the clinical diagnosis was ABC. After operation, the patient was treated with 8 cycles of AC-T regimen adjuvant chemotherapy (The first four cycles were given pirarubicin 60 mg · m-2, cyclophosphamide 600 mg · m-2 per cycle; the last four cycles were given docetaxel 100 mg · m-2 per cycle; every three weeks was a cycle of treatment), radiation therapy (The radiation dose was 50 Gy/25 f in the upper and lower part of the right collarbone and the tumor bed area, and after retract the tumor bed area was increased to 60 Gy) and endocrine therapy (Tamoxifen was administered at 20 mg per day). Results: The patient's breast color ultrasound and mammogram examination indicated that the right axillary mass of the patient was more likely to be malignant. The clinical diagnosis was right axillary ABC. According to the NCCN guide, the patient was treated with the standardized comprehensive treatment based on surgical treatment. 16 months after operation, the patient recovered well and had a normal life. There was no upper limb dysfunction and no lateral upper limb lymphedema, and there were no recurrence or metastasis Conclusion: ABC is extremely rarely seen in clinical practice. The clinical pathological features and treatment of ABC are similar to breast cancer. If there is no lesion in the mammary gland, it is not necessary to remove the mammary gland in the affected side.

Feasibility of avoiding axillary lymph node dissection in early breast cancer patients with positive sentinel lymph nodes / 天津医药

Objective To explore the feasibility of omitting axillary lymph node dissection (ALND) in early breast cancer patients with positive sentinel lymph nodes (SLN). Methods Clinical data of 591 patients with primary breast cancer treated in our hospital from September 2014 to September 2016 were collected.According to the SLN status,patients were divided into SLN (-) group (n=320), SLN (+) =1 group (n=172), SLN (+)=2 group (n=72) and SLN≥3 group (n=27). ALND was performed in all patients after sentinel lymph node biopsy (SLNB). The positive rates of axillary lymph node (ALN)were compared between groups.Results The positive rates of ALN were 5.0%(16/320),8.1%(14/172),16.7%(12/72)and 37.0%(10/27)in SLN(-)group,SLN(+)=1 group,SLN(+)=2 group and SLN≥3 group respectively.There was no significant difference in the positive rate of ALN between SLN (-) group and SLN (+) =1 group (χ2=1.926,P=0.165). The positive rate of ALN was significantly higher in SLN(+)=2 group than that of SLN(-)group(χ2=12.062,P=0.001)and SLN (+)=1 group(χ2=3.876,P=0.049).The positive rate of ALN was significantly higher in the SLN(+)≥3 group than that in the SLN(-)group(χ2=32.939,P<0.001)and SLN(+)=1 group(χ2=15.751,P<0.001)and SLN(+)=2 group(χ2=4.714,P=0.030). Conclusion The patients with 1 SLN positive can be considered to exempt from ALND,while the patients with 2 or more SLN positive may be recommended ALND.

Clinical significance and treatment regimen of sentinel lymph node microscopic metastasis in breast cancer / 中华普通外科杂志

Objective To explore the clinical significance and treatment regimen of sentinel lymph node(SLN) micrometastases and isolated tumor cell metastasis in breast cancer.Methods Ninety-seven breast cancer patients with sentinel lymph node micrometastases or isolated tumor cell metastasis from January 2013 to December 2015 were retrospectively studied.The patients were assigned to axillary lymph node dissection group (ALND,41 cases) and non axillary lymph node dissection group(non-ALND,56 cases) according to the final surgery mode to the axilla.Disease-free survival(DFS) and overall survival (OS) were compared between the two groups.Results Neither clinico-pathological factors,such as age,tumor size,grade,ER/PR status,HER-2 gene expression,Ki-67 expression and the size of the SLN metastasis,nor the treatment,such as breast surgery,postoperative adjuvant chemotherapy,radiotherapy and hormone therapy were found statistically different between the two groups (P ＞ 0.05).There were 96 patients evaluable with a median follow up of 24 months.The DFS of the ALND and non-ALND group was 97.5％ and 96.6％ (P ＞ 0.05),and the OS was 100％ and 98.2％ (P ＞ 0.05) respectively with no difference between the two groups.There were 2 ispilateral axillary recurrence in the non-ALND group and non in the ALND group.Conclusion Axillary lymph node dissection may be omitted for the breast cancer patients with sentinel lymph node micrometastases and isolated tumor cell metastases.But the postoperative adjuvant systemic treatment should be emphasized.

A application evaluation of sentinel lymph node biopsy and axillary lymph node dissection under mastoscopy for patients with early stage breast cancer in clinical diagnosis and treatment / 中国医学装备

Objective: To explore the advantages and evaluate feasibility of sentinel lymph node (SLN) biopsy and axillary lymph node dissection under mastoscopy for patients with early stage breast cancer in clinical diagnosis and treatment. Methods: 200 patients with breast cancer stage I and II diagnosed by breast surgery were divided into observation group (100 cases) and control group (100 cases) as different surgery method. The patients of observation group were treated by SLN biopsy and axillary lymph node dissection under mastoscopy, while those of control group were treated by traditional open surgery. To analyze the detection rate and accuracy rate, and compare the bleeding volume during operation, the operation time and hospitalization time between the two groups. And series of indexes, such as incidence of post-operative complication, recurrence rate and good appearance rate of breast were compared between the two groups. Results: The difference of accuracy rate between the two groups was no significant. The incidence of complication, good appearance rate of breast and recurrence rate of observation group were, respectively, 4%, 92% and 4%. And the differences between those results of observation group and those of control group were significant (x2=25.25, x2=16.61, x2=170.40; P<0.05). Other some indexes, such as the bleeding volume during operation, the operation time and hospitalization time, the differences between observation group and control group also were significant (t=9.73, t=13.86, t=11.66; P<0.05). Conclusion:Sentinel lymph node (SLN) biopsy and axillary lymph node dissection under mastoscopy are feasibility in clinical practice based on its series advantages, such as better detection rate, lower incidence of complication, better protection for breast appearance and so on.

Síndrome de Stewart-Treves / Stewart-Treves Syndrome

El síndrome de Stewart-Treves es un angiosarcoma cutáneo, poco frecuente, que se produce en pacientes con linfedema crónico. Se describe clásicamente luego de realizar mastectomía radical con vaciamiento ganglionar y/o radioterapia. Su mortalidad es elevada. Comunicamos el caso de una paciente de 76 años de edad, sometida a mastectomía radical con vaciamiento ganglionar axilar, seguido de quimioterapia y radioterapia. Consulta 13 años después por dolor intenso y lesión tumoral exofitica, ulcerada, angiomatosa, sangrante y maloliente en cara anterior del brazo izquierdo. Presentaba edema del miembro de varios años de evolución. Luego de realizar biopsia por punch de la lesión, los resultados histopatológicos resultaron compatibles con linfangiosarcoma. La familia junto con el servicio de Cirugía decide realizar la extirpación del tumor, con conservación del miembro. Falleció luego de once meses de realizado el diagnóstico de síndrome de Stewart-Treves, en nuestro Servicio.

The Stewart-Treves Syndrome is a rare cutaneous angiosarcoma, that occurs in patients with chronic lymphedema. It is classically described after performing radical mastectomy with lymph node dissection and/or radiation therapy. Its mortality is high. We have reported the case of a 76 years old patient, who underwent radical mastectomy with axillary lymph node dissection, followed by chemotherapy and radiotherapy. She came 13 years later with an intense pain and exophytic, ulcerated, angiomatous, bleeding and smelly tumor injury in front side of the left arm. She had an edema of the left upper limb with several years of evolution. After performing punch biopsy of the lesion the histopathological results were compatible with lymphangiosarcoma. The family, jointly with the surgery service decided to remove the tumor with limb preservation. She died 11 months after the diagnosis of Stewart-Treves syndrome, performed in our department.

Analysis of eleven cases of sentinel lymph node biopsy in male breast cancer / 国际外科学杂志

Objective To evaluate the performance and feasibility of sentinel node biopsy(SNB) in male breast cancer patients using Methylthioninium Chloride Injection.Methods At the First Affiliated Hospital of Zhengzhou University,there are 11 patients in group from March 2010 to December 2014.The clinical stage was cT1-T2N0M0.All patients using Methylthioninium Chloride Injection as the tracer.11 patients are given with sentinel lymph node biopsy,while given the axillary lymph node dissection.Results In 11 cases of male breast cancer patients,10 cases obtained the sentinel lymph nodes,the detection rate was 90.9％ (10/11).The sentinel lymph node is in 1-3,the average is 1.7 gold.Non sentinel lymph nodes are in 8-14,the average is 10.5 gold.The coincidence rate is 90.0％ The sensitivity is 100％ and The precision is 60％.Conclusions Sentinel lymph node biopsy can accurately predict the metastasis of axillary lymph node of breast cancer in male patients.

The exportability of the criteria defined by Z0011 trial for selecting patients who are eligible for omitting ALND after a positive SLNB result in China / 中国癌症杂志

Background and purpose:The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has been described as practice-changing of sentinel lymph node (SLN) positive breast cancers. The goal of this study was to determine the exportability of the criteria deifned by Z0011 trial for selecting patients who are eligible for avoiding axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) result in China.Methods:We collected 194 breast cancer patients with positive SLNs and classiifed them into two groups according to Z0011 criteria. One group was consisted of patients who were eligible for omitting ALND and with SLNB only. The other one was ALND group. Then the patients of SLNB group were compared with cohort included in the Z0011 trial and the ALND group of this study separately.Results:Seventy-seven patients were potentially eligible for omitting ALND and 117 patients were still needed to have ALND. Compared with Z0011 cohort, the SLNB group in this research had signiifcantly more T1 stage and ER positive tumors (P<0.05). More patients in SLNB group had positive LNs with the number less than 3 and negative NSLNs (P<0.05). The ALND group had more T2 and T3 stage tumors than the SLNB group but the difference was not signiifcantly. The number of positive LNs in ALND group was higher than the SLNB group signiifcantly (P<0.05). More patients in the ALND group had positive non-sentinel lymph node (NSLN) than the SLNB group and the difference was also signiifcantly (P<0.05).Conclusion:Applied to the SLN positive patients in this study, Z0011 criteria could make patients with better prognosis and lower risk than Z0011 cohort be selected and let these patients avoiding ALND more safely.

Axillary lymph node dissection for breast cancer patients with negative sentinel node biopsy:a sys-temic review / 临床外科杂志

Objective To systematically evaluate the effectiveness and safety of axillary lymph node dissection for breast cancer patients with negative sentinel node biopsy.Methods Literatures in CNKI,PubMed,EMBASE and CBMwere searched from their establishment to December 1,2013.Accord-ing to the inclusion and exclusion criteria,trials of axillary lymph node dissection and sentinel node biopsy for breast cancer were strictly screened and extracted for quality assessment and result analysis.Meta-anal-ysis was conducted by using Revman 5.1 software.Results A total of 10 studies involving 7731 patients were eligible for the final analysis.Because of the large differences in research type,measurement indica-tor,follow-up period and statistical index,subgroup analysis was adopted.Meta-analysis was applied for homogeneous researches and the remaining studies were analyzed with qualitative descriptive analysis.The results showed no significant differences in disease-free survival,overall survival,local recurrence rate,and distant metastasis rate in different follow-up periods.Conclusion For breast cancer patients with single invasive lesion,axillary lymph node dissection is not necessary.More high-quality random control trials and long-term follow-up are required to confirm the conclusions of this systematic review.

Impacto de las metástasis del linfonodo centinela y su tamaño, en el tratamiento del cáncer de mama / Impact of sentinel lymph node metastases in the treatment of breast cancer

Introducción: La importancia de las metástasis encontradas en linfonodos centinelas (LC) de pacientes con cáncer de mama ha sido cuestionada, por lo que frente al hallazgo de éstas, la observación sin disección axilar (DA), asociada a terapias adyuvantes, ha sido considerada como una alternativa en los últimos años. Objetivo: Evaluar las macro (MA), micro (MI) y submicrometástasis (SM) de cáncer de mama en LC, y su impacto en la DA posterior. Materiales y Métodos: Se revisaron los resultados de las biopsias de pacientes con cáncer de mama invasor con MA, MI y SM encontradas en el LC operadas en nuestra institución, entre mayo de 1999 y diciembre de 2011. Resultados: Se encontraron 134 pacientes con MA, 33 pacientes con MI y 30 SM, dentro de 632 pacientes con cáncer de mama invasor a los que se les realizó LC. De estos se operaron 130, 24 y 17 pacientes, respectivamente. La frecuencia de Linfonodos No Centinelas (LNC) con metástasis encontradas en la DA fue de 46,9 por ciento (61/130) para MA, 33,3 por ciento (8/24) para MI y 23,5 por ciento (4/17) para SM. Las metástasis del LNC provenientes de MA modificaron el TNM en 26,9 por ciento (35/130), las provenientes de MI en 20,8 por ciento (5/24) pacientes, mientras que las SM sólo lo modificaron en un paciente (5,9 por ciento). Conclusiones: La frecuencia del compromiso linfonodal en la DA es significativamente mayor en las pacientes con MA. El número de DA sin claro aporte terapéutico es alto y aumenta al disminuir el tamaño de las metástasis en el LC. Los resultados apoyan no realizar la DA en pacientes con MI y SM en el LC, que hayan recibido tratamiento quirúrgico conservador y vayan a recibir adyuvancia sistémica.

Introduction: The importance of sentinel lymph nodes (SL) metastasis at breast cancer patients has been questioned and observation without axillary dissection (AD) associated with adjuvant therapies has been the recommendation in recent years. Objective: To evaluate the macro (MA), micro (MI) and submicrometastasis (SM) of breast cancer in SL, and their impact on the posterior AD. Methods: We reviewed results of biopsies from patients with invasive breast cancer with MA, MI and SM found in the SL operated at our institution between May 1999 and December 2011. Results: We found 134 patients with MA, 33 patients with MI and 30 patients with SM, in a total of 632 patients with invasive breast cancer in those who underwent SL. These were operated 130, 24 and 17 patients respectively. The frequency of no sentinels lymph nodes (NSL) with metastases found on AD was 46.9% (61/130) for MA, 33.3% (8/24) for MI and 23.5% (4/17) for SM. The NSL metastasis from MA modified the TNM in 26.9% (35/130), those from MI in 20.8% (5/24) patients, while the SM only modified in one patient (5.9%). Conclusions: The frequency of lymph nodal involvement in AD is significantly higher in patients with MA. The number of AD without clear therapeutic input is high and increases with decreasing size of SL metastases. The results support to not perform AD in patients with MI and SM in the SL, who received conservative surgery and adjuvant therapy.

Comparative Analysis of Limb Dysfunction in Different Surgical Breast Cancer / 中国康复理论与实践

@#Objective To compare the incidence of limb dysfunction, sensory disturbance and lymphedema after different treatment methods in breast cancer patients, and evaluate the clinically relevant factors of limb dysfunction. Methods According to the different processing operation of axillary lymph nodes, 235 patients with breast cancer during 2005 to 2012 were divided into axillary lymph node dissection group in Mastoscopy (group A, n=120) and routine axillary lymph node dissection group (group B, n=115). The flexion, extension, abduction, adduction activity of the ipsilateral shoulder were compared with the contralateral, and the circumference of the up-and-down 15 cm of both upper limbs olecroanon were measured. The incidence of limb dysfunction of the patients was followed up in 6 months, 1 year and 2 years. Results There was no significant difference in limb activity and sensory disturbance between 2 groups 6 months, 1 year and 2 years after operation (P>0.05), the incidence of limb lymphedema was higher in group B than in group A (P<0.05). Radiotherapy was related with limb lymphedema in both groups (P<0.05). Conclusion Compared with the conventional axillary lymph node dissection, endoscopic axillary lymph node dissection can reduce the incidence of limb lymphedema after operation, but there was no significant difference in the limb activity and sensory disturbance between 2 groups. Postoperative radiotherapy is a risk to increase the occurrence of limb lymphedema.