The Research In Application Value Of Methylene Blue Coloration Technique In Axillary Lymph Node Dissection Of Breast Cancer

Objective1.To observe the coloration of methylene blue in the patients with breast cancer in axillary lymph node dissection,and analyze the clinical factors that affect the coloration of methylene blue.2.To confirm the optimal time and position of the methylene blue coloration technique in axillary lymph node dissection.3.To observe the coloration of methylene blue in the lymph nodes of axillary specific region,and analyze the metastasis,Which can determine whether the lymph nodes the lymph node upper axillary vein are necessary to remove,and the importance of subscapular lymph nodes in the axillary lymph node metastasis of breast cancer in order to guide the surgical treatment.Methods1.170 patients with breast cancer between December 2016 and December 2017 in the Department Of Second Breast Surgery of Yunnan Cancer Hospital,who underwent axillary lymph nodes dissection(ALND)according to clinical guidelines,were injected methylene blue before operation.To observe the coloration of methylene blue,and analyze the effects of age,BMI,molecular typing,TNM staging,and neoadjuvant chemotherapy.2,To inject methylene blue in 10 minutes,20 minutes,30 minutes,40 minutes,60 minutes,120 minutes,240 minutes before operation,in order to confirm the optimal time.A total of 120 cases of methylene blue were selected from 10 to 40 minutes,to inject methylene blue in areola or outer upper quadrant,in order to confirm the optimal position.3.In all cases,84 cases were selected to sent the lymph nodes of axillary specific region separately,including the lymph node upper axillary vein,and the scapular lymph node.To observe the coloration of methylene blue there,and compare the metastasis in two specific regions.Results1.Effects of methylene blue color technique1.1 Clinical factors:170 cases in the research,138 cases were colored,81.17%of total cases.32 cases didn’t be colored,accounting for 18.83%.Statistical analysis of clinical factors affecting the coloration of methylene blue,There are no significant differences in ages,molecular type of breast cancer,TNM stage and neoadjuvant chemotherapy(P>0.05).BMI value has significant differences on the color of methylene blue(P<0.05).1.2 The optimal time and position of injecting methylene blue:To inject methylene blue in 10 minutes,20 minutes,30 minutes,40 minutes,60 minutes,the color rate can ensure more than 70%.In 10 minutes,20 minutes,30 minutes,the color rate can ensure more than 90%.There is no significant difference in the position of areola or outer upper quadrant(P>0.05).2.The lymph node upper axillary vein and scapular lymph node2.1 Comparation the lymph node of axillary specific region and the lymph node of axillary:84 cases in the research,it can be seen that methylene blue crosses the axillary vein,making the lymph nodes above the axillary vein appear color,when the coloration is optimal.We detected axillary metastatic lymph node were 0,1～3,4～9 and above 9,the cases with metastatic lymph node upper axillary vein were 0,2,4 and 6,accounted for 0,2.3%,4.7%,and 7.1%of the total number of cases.The cases with metastatic lymph node of scapular were 0,1,2 and 5,accounted for 0,1.1%,2.3%,and 5.9%of the total number of cases.2.2 Comparation the lymph node upper axillary vein and scapular lymph node:There are no significant differences in the numbers of lymph node metastasis and the positive rate of the lymph node upper axillary vein and scapular lymph node.2 Patients with metastases lymph nodes both two specific regions,had 9 lymph nodes detected,all of them were metastatic lymph node,the positive rate is 100%.Conclusions1.Effects of methylene blue color technique1.1 Clinical factors:There are no significant differences in ages,molecular type of breast cancer,TNM stage and neoadjuvant chemotherapy(P>0.05).BMI value has significant differences on the color of methylene blue(P<0.05),which suggested that the coloration effect of methylene blue is mainly affected by the size and weight of the patient in breast cancer patients,the fatter the patient,the worse the coloration.1.2 The optimal time of injecting methylene blue:The optimal injection time is 10～30 minutes before ALND.1.3 The optimal position of injecting methylene blue:There is no significant difference in the position of areola or outer upper quadrant.2.The lymph node upper axillary vein and scapular lymph nodeThis study confirms that the lymph node upper axillary vein also belongs to the axillary lymphatic drainage area.With the increase of the metastatic lymph nodes detected in the axilla,the cases of metastasis upper axillary vein and scapular lymph node increased,and the positive rate increased.But there are no obvious correlation in the lymph node upper axillary vein and scapular lymph node.In ALND,it is essential to pay more attention to the lymph node upper axillary vein and scapular lymph node.3.Application of the methylene blue color technology in breast cancer with ALND:The value of methylene blue color technology in the sentinel lymph node biopsy of breast cancer has been widely recognized.With this technology,lymph nodes can be clearly identified during the surgery,which has great guiding value for the doctors who learning the operation initially and primary hospital.