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.

Ganglio centinela en cáncer de mama: experiencia 2000-2010 en el Instituto Nacional de Cancerología de Colombia / Sentinal lymph node in breast cancer: experience at the National Cancer Institute of Colombia 2000-2010

Objetivos: El presente estudio describe las características clínicas y epidemiológicas de las pacientes con cáncer de mama a quienes se les aplicó la técnica del ganglio centinela en el Servicio de Seno y Tejidos Blandos del Instituto Nacional de Cancerología (INC), en 10 años de experiencia. Métodos: Serie de casos de pacientes con diagnóstico de cáncer de mama temprano en estadios 0-IIB (T3N0M0), a quienes se les realizó la técnica. A partir de registros de los servicios de Patología, Medicina Nuclear y Cirugía de Seno y Tejidos Blandos del INC, se realizó la captura de datos aplicando un cuestionario previamente elaborado. Resultados: Se tomaron en cuenta 289 casos; las técnicas usadas incluyeron: radio coloides (Tecnecio 99) en 256 casos; colorante, en 5; y ambas técnicas, en los 28 restantes. El ganglio centinela fue identificado en 283 casos, con una tasa de detección del 98,0%. En carcinoma invasor, el tamaño tumoral promedio fue 2,2 cm (DE 1,1). En promedio, fueron resecados 1,5 ganglios (0,99 DE); de estos casos, 85 (30%) fueron metastásicos. Hubo 24 eventos adversos; el más común fue la formación de seroma. La media de seguimiento fue de 647 días (DE 693 días); el porcentaje de pacientes libres de enfermedad al seguimiento, del 94,4%; hubo recaída axilar en 1 paciente. Conclusiones: Según los autores de la experiencia descrita, la técnica de ganglio centinela es segura, pues permite una estadificación adecuada de la axila. Las características tumorales del ganglio centinela en la población objeto de estudio guardan similitud con las reportadas en la literatura mundial.

Objectives: This study describes the clinical and epidemiologic characteristics of breast cancer patients who were treated with sentinal node in breast service and soft tissue procedure at the National Cancer Institute during a 10-year period. Methods: Two hundred and eighty-nine (289) cases were included, and the techniques used were: radio colloids (Technetium 99) in 256 cases; dye in 5 cases; and both procedures in the remaining 28 cases. Sentinal lymph nodes were identified in 283 cases with a detection rate of 98.0%. In the case of invasive carcinoma, average tumor size was 2.2 cm (DE 1.1). On average, 1.5 ganglia (0.99) were resected; of these cases, 85 were metastatic (30%). There were 24 adverse events, the most frequent being seroma formation. Mean follow-up was 647 days (DE 693 days); percentage of disease-free patients during follow-up was 94.4%; axillary relapse occurred in 1 patient. Results: The procedure was performed on a series of patient cases with early breast cancer diagnosis in stages O-11B (T3NOMO). Data were compiled by utilizing a previously prepared questionnaire and on the basis of registries from the departments of pathology, nuclear medicine and breast and soft tissue surgeries at the National Cancer Institute. Conclusions: In our experience, the sentinal node procedure has proven to safely allow for the adequate stratification of the axilla. The tumoral characteristics of the sentinal lymph node in the population under study shared similarities with those reported in the international literature.

Reação anafilática ao corante azul patente durante a biópsia do linfonodo sentinela em câncer de mama inicial: relato de caso / Anaphylactic reaction to patent blue dye during sentinel lymph node biopsy in early-stage breast cancer: a case report

A biópsia do linfonodo sentinela no tratamento do câncer de mama vem substituindo a linfadenectomia em casos iniciais. Este tratamento pode ser realizado com o corante azul vital e/ou radiofármaco. Há relatos de reações alérgicas ao corante com diferentes graus de severidade. Relata-se um caso de reação anafilática severa após injeção intradérmica do corante azul patente, em paciente com diagnóstico de carcinoma ductal in situ. O corante azul patente, apesar de facilitar a detecção do linfonodo, apresenta risco de desencadear reações anafilactóides. É necessário que a equipe envolvida tenha preparo para diagnosticar e tratar esta complicação.

Sentinel lymph node biopsy in the treatment of breast cancer has been replacing lymph node resection in early cases. This treatment may be performed with blue dye and/or radiopharmaceuticals. There are reports of allergic reactions to blue dye with different degrees of severity. A case of severe anaphylactic reaction after intradermal injection of patent blue dye was reported in a patient diagnosed with ductal carcinoma in situ. The patent blue dye facilitates the detection of the sentinel lymph node, but there is the risk of triggering anaphylactic reactions. It is recommended the team involved to be very knowledgeable and prepared to diganose and treat this complication.