Lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node

doi:10.16139/j.1007-9610.2019.05.013

Abstract

Abstract: Objective To study lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node (SLN). Methods From January 2015 to January 2017, a total of 718 patients of breast cancer with negative SLN had mastectomy and lower axillary lymph node dissection in both our department and Department of Surgery Comprehensive Breast Health Center Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Metastasis rate of lower axillary lymph node and the factors related to metastasis were analyzed. Results Lower axillary lymph node was identified in 686 cases (95.5%) with (9.35±5.684) (0~21) lymph node per patients on average. Metastasis to lower axillary lymph nodes was found in 40 patients (5.6%, 40/718). Single-variant analysis showed that metastasis of lower axillary lymph nodes was related to enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, HER2 positive, and molecular classification (P<0.05). Independent risk factors associated with lower axillary lymph node metastasis were shown in multivariate Logistic analysis including enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, and molecular classification. There were 5 (0.7%) cases with postoperative upper limb lymphedema, and upper limb dysfunction was not found. Conclusions Metastasis of lower axillary lymph node was present combined with multiple risk factors in the patients of breast cancer with negative SLN and should be dissected.

Key words: Breast cancer, Sentinel lymph node, Low axillary lymph node, Clinical anatomy rate

CLC Number:

R737.9

WEN Tao, FANG Zhen, WANG Ke, SHE Qiuman, ZHENG Jingyan, HUANG Kaiming, SHI Yong. Lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node[J]. Journal of Surgery Concepts & Practice, 2019, 24(05): 434-439.

References

[1] Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial[J]. Ann Surg,2010, 252(3):426-433.
[2] Giuliano AE, Hunt KK, Ballman KV, et al.Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial[J]. JAMA,2011,305(6):569-575.
[3] Krag DN, Anderson SJ, Julian TB, et al.Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol,2010,11(10):927-933.
[4] Goldgirsch A, Ingle JN, Gelber RD, et al.Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009[J]. Ann Oncol,2009,20(8):1319-1329.
[5] 惠锐. 乳腺癌腋窝淋巴结跳跃式转移规律的临床研究[J]. 现代肿瘤医学,2004,12(2):166-167.
[6] 刘轩, 张信来, 布日古德. 前哨淋巴结活检阴性乳腺癌患者行低位部分腋窝淋巴结清扫的必要性探讨[J]. 肿瘤防治研究,2018,45(12):64-67.
[7] 张月秋, 李勇, 孙宝臣, 等. 前哨淋巴结阴性患者补充低位腋淋巴结清扫的临床研究[J]. 中国医学创新, 2013,10(33):130-132.
[8] 黄兴伟, 湛本珠, 黄居林, 等. 乳腺癌全乳切除加低位腋窝淋巴结清除术的远期疗效[J]. 江西医学院学报,2003,43(2):73-74.
[9] Goldhirsch A, Winer EP, Coates AS, et al.Personalizing the treatment of women with early breast cancer: high- lights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol,2013,24(9):2206-2223.
[10] Mamounas EP, Kuehn T, Rutgers EJT, et al. Current approach of the axilla in patients with early-stage breast cancer[J]. Lancet,2017.pii:S0140-6736(17)31451-4.
[11] 江泽飞, 王永胜. 2009年第Ⅱ届St.Gallen国际早期乳腺癌治疗研讨会:争议与共识[J/CD]中华乳腺病杂志(电子版),2009,3(4):381-386.
[12] Jagsi R, Chadha M, Moni J, et al.Radiation field design in the ACOSOG Z0011 (Alliance) Trial[J]. J Clin Oncol,2014,32(32):3600-3606.
[13] 方帆, 李莉, 高妮娜, 等. 冷冻快速切片的免疫组织化学检测辅助诊断乳腺癌前哨淋巴结转移癌[J]. 华夏医学,2013,26(6):1040-1043.
[14] 沈坤炜, 沈镇宙. 乳腺癌哨兵淋巴结活检的现状和展望[J]. 中国癌症杂志,1999,9(5-6):121-123.
[15] 吴慧, 曾可斌, 沈方媛. 乳腺癌前哨淋巴结假阴性率的影响因素分析[J]. 现代医药卫生,2018,34(14):2189-2192.
[16] Hayes SC, Johansson K, Stout NL, et al.Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care[J]. Cancer,2012, 118(8 Suppl):2237-2249.
[17] Abass MO, Gismall AM, Alsheikh AA, et al.Axillary lymph node dissection for breast cancer: efficacy and complication in developing countries[J]. J Glob Oncol,2018,4:1-8.
[18] Robinson DS, Senofsky GM, Ketcham AS.Role and extent of lymphadenectomy for early breast cancer[J]. Semin Surg Oncol,1992,8(2):78-82.
[19] Thompson M, Korourian S, Henry-Tillman R, et al.Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation[J]. Ann Surg Oncol,2007,14(6):1890-1895.
[20] 贾实, 李建一, 张文海, 等. 乳腺癌腋窝清扫术中上肢淋巴结定位及转移规律的研究[J]. 中国医科大学学报,2012,41(5):450-453.