Minimize the extent and morbidity of axillary dissection for node-positive breast cancer patients: implementation of axillary lymph node dissection based on breast lymphatics level

• Published in: BMC cancer Vol. 21; no. 1; p. 293
• Main Authors: Yuan, Qianqian, Hou, Jinxuan, He, Yukun, Liao, Yiqian, Zheng, Lewei, Wu, Gaosong
• Format: Journal Article
• Language: English
• Published: England BioMed Central 19.03.2021; BMC
• Subjects: Axilla; Axillary lymph node dissection; Breast - pathology; Breast - surgery; Breast cancer; Breast cancer related lymphedema; Breast Neoplasms - complications; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Dissection; Female; Humans; Indocyanine Green - administration & dosage; Intraoperative Care - methods; Lymph Node Excision - adverse effects; Lymph Node Excision - standards; Lymphatic Metastasis - diagnosis; Lymphatic Metastasis - pathology; Lymphatic Metastasis - therapy; Lymphedema - diagnosis; Lymphedema - etiology; Lymphedema - surgery; Mastectomy - methods; Middle Aged; Pilot Projects; Practice Guidelines as Topic; Prospective Studies; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy; Breast cancer related lymphedema; Breast cancer; Axillary lymph node dissection
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08024-y

Breast cancer-related lymphedema (BCRL) is associated with extensive axillary dissection. Axillary lymph node dissection (ALND) based on breast lymphatics level (BLL) was proposed to minimize the surgical extent for node-positive breast cancer patients. A total of 156 consecutive sentinel lymph node-positive (SLN+) or clinically node-positive (cN+) patients underwent sentinel lymph node biopsy (SLNB) with indocyanine green and methylene blue (MB). The SLNs were injected with 0.1 ml MB before removal, and a standard ALND was subsequently performed. The nodes adjacent to the blue-stained axillary lymph nodes from the breast (bALNs) were sent for pathological examination separately by resecting serial tissue every 0.5 cm away from the marginal blue-stained bALNs. Then, a pilot study comparing ALND based on BLL and standard ALND was performed. BLL were successfully identified in 20 SLN+ (100%) and 134 cN+ (98.5%) patients. The median number of BLL was four, ranging from three to six. A horizontal line 1.0 cm away from the superior blue-stained bALN and a vertical line 1.0 cm away from the medial blue-stained bALN formed BLL II, III, and IV. All of the additional positive nodes were within 1.0 cm of the blue-stained bALNs. The minimized axillary dissection should resect upwards from the lowest BLL that contains the first confirmed negative blue-stained bALNs. In the pilot study, no patient developed axillary recurrence. The ALND surgical procedure based on BLL could minimize the surgical extent for pathological node-positive breast cancer patients and potentially reduce the BCRL rate. ChiCTR1800014247 .