The Relationship Between The Levels Of Axillary Lymphnodes Metastasis Of Breast Cancer

Breast cancer is one of the most harmful disease to the health of women..The morbidity of breast cancer increases year by year under the influence of some extrinsic factor such as living habit and so on. Lymph-path is the main way of metastasis for the early stage breast cancer. The axillary lymph-path drains nearly 70% of the lymph fluid in breast. It's also the most common place where the local metastasis of braest cancer takes place. Axillary lymphnodes contain plenty of information which is of great importance to the treatment of breast cancer. The statue of axillary lymphnodes have great value for the doctors in getting the procedure of the disease ,estimating prognosis and making decision in treatment.It plays a role of"road sign"to the surgeons and oncologists.And that was the main reason for the researchers'keeping studying the regularity of the lymphnodes metastasis in breast cancer.In surgery , we usually take the upper and lower edges of pectoralis minor as the boundary of the three levels of axllary lymohnodes. The lymphnodes beneath the lower edge of pectoralis minor are the levelâ… lymphnodes . The one behind the deeper side of pectoralis minor are the levelâ…¡lymphnodes. And the one above the upper edge of pectoralis minor are the levelâ…¢.The lymphnodes between the deeper side of pectoralis major and the upper side of pectoralis minor are called Rotter's lymphnodes.This group of lymphnodes has a special meaning as another path of lymphnodes metastasis of breast cancer. They can be reached in the axillary lymphnodes dissection(ALND), so they are usually one group of the levels of lymphnodes being removed in ALND. The basic principle on the circumscription of ALND is that: if the result of sentinel lymphnode biopsy(SLNB) was negative,ALND could be avoided. If the result of SLNB was positive,or in the case that a patient didn't accept SLNB,the ALND must be done. If there was no finding of positive nodes in the operation,or there were positive nodes in levelâ… only, the lymphnodes being removed should include levelâ… and levelâ…¡lymphnodes. If there were positive nodes in levelâ…¡, the lymphnodes being removed should include levelâ…¢and Rotter's lymphnodes. As the increasing of people's awareness of health,and the progressing of the diagnostic technique, the diagnose rate of early stage breast cancer rise continually. Most early stage breast cancer patients are node-negtive or merely have positive nodes in the minor parts of levelâ… lymphnodes.Patients and doctors usually have the same request in curative effect of disease. In the meanwhile, they begin to pay more attention to the post-operation life quality. The tendency of reducing the circumscription of operation not only is showed in the changing of operation method from mastectomy to modified mastectomy and to lumtectomy, but also showed in minimizing the injury in ALND in the premise of getting exact axillary imformation..Nevertheless,the operation method we use today will cause some degree of overtreatment to the early stage breast cancer patients.For example,most early stage patients with node-negtive or 1-3 nodes positive in levelâ… only will still accept a levelâ…¡dissection at least according to the routine. It was reported in both domestic and abroad documents that enlarging the circumscription of ALND didn't benefit the patients. On the contrary, it increased the possibility of arm complication . So our research set target on studying the regularity between the levels of axillary nodes metastasis to find the opportunity to minimize the circumscription for some early stage patients.Our research selected operable breast cancer patients without any new neoadjuvant treatment as target,gave them a standard modified mastectomy and a total axillary lymphnodes dissection to get more intact and accurate axillary information. The lymphnodes sample were divided into four group as level I , level II, levelâ…¢and Rotter's lymphnodes,then sent to pathologic examination separately. In the imformation we got, we emphasized analyzing the regularity between the level I and level II metastasis ,and tried to find the opportunity to minimize the circumscription for the early stage patients. The detail data shows as below: there is 55 (63.2%)patients with negative nodes and 32(36.8%) patients with positive nodes in total 87 patients. There is one patient with Rotter's lymphnodes skip metastasis in the level I negative patients.24 patients have 1-3 positive nodes in level I, in which there are 22(91.7%) patients with negative level II nodes , one patient with positive level II nodes and one with Rotter's lymphnode skip metastasis(8.3% together). 7 patients have more than 3 positive nodes in level I, in which there are 2(28.6%) patients with negative level II nodes , one patient(14.3%) with 1-3 positive level II nodes ,3 patient(42.9%) with 4-9 positive level II nodes, one patient(14.3%) with more than 9 positive level II nodes and 4 (57.1%)with levelâ…¢metastasis. By ananlysing the data, we can see that the level I negative and 1-3 positive patients have a relative low rate of level II nodes metastasis.But the possibility of the Rotter's lymphnode skip metastasis can not be neglected. According to the documents, level I 1-3 positive patients have more opportunity of level II nodes metastasis and skip metastasis than level I negative patients. So we gained the conclusion as below: 1.It dose exist in abstracto the feasibility of giving level I dissection to the patients with no clinical evidence of nodes-positive and no findings of positive nodes in the procedure of operation. 2.The patients which were found 1-3 level I nodes positive should accept a at least level II dissection.3.Detecting Rotter's lymphnodes during operation is a necessary step to determine wether a low level dissection should be done or the circumscription of axillary dissection.The result of our research suggests a more rational circumscription of ALND to early stage breast cancer patients.It will reduce the injury caused by overtreatment. And it meet the view that we should consider breast cancer as a systemic disease , emphasize general treatment more than local treatment, and reduce the unnecessary injury of local treatment as much as possible. The shortage of our research is that the conclusion stays in the category of a theory. It still take a long way to go to realize a modification of operation method. In our next research ,we will enlarge the number of samples,and set negative control group in order to compare the possibility of complications, RFS and OS. It can be expected that ,as the research progressing, our research would suggest a more reasonable circumscription of ALND and contribute to the improving of the post-operating living quality of early stage breast cancer patients.