A clinical study on upper limb lymph-node-conserving surgery in axillary lymph node dissection for early breast cancer / 中华内分泌外科杂志

ABSTRACT

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.