| Objective The purpose of this trial is to study the feasibility of the axillary reverse mapping(ARM) and the security of the ARM nodes in patients with clinically node positive breast cancer when they undergoing axillary lymph node dissection(ALND).Methods This study from October 2015 to March 2016 involved patients with clinically node positive undergoing ALND. In the preoperative 4~12h, 0.5ml of nanocarbon was injected subcutaneously in the median intramuscular groove of the ipsilateral upper inner arm, massage the injection site 2min, to promote the lymphatic drainage of the upper arm. When undergoing ALND, date was collected on variations in ARM successfully developing, staining lymph nodes and the pathology, total number of axillary lymph nodes dissected, positive nodes, and the final pathological stage. Then analyse the feasibility and security of ARM.Results According to preoperative imaging examination and palpation, 24 patients are clinically node positive breast cancer, agreed to have the modified radical mastectomy and ARM. Of the 24 patients, the lymph node of 22 cases belongs to clinical N1, 2 with clinical N2. In 22 cases of N1, 21 cases had stained lymphatics or nodes identified, with the average number of stained nodes is 1.95, the average number of lymph nodes dissected is 17.5, all stained lymph modes are negative. According to the metastasis of lymph nodes after surgery, of 22 clinical N1 cases, 5 is pN2, 1 is pN3, the only one with failed ARM confirmed to be pN2. The remaining 2 with clinical stage of N2, one had successfully ARM procedure, with 2 negative ARM nodes. The 2 clinical N2 cases confirmed to be pN3.Conclusions For patients with clinically node positive, tracing the ARM with nanocarbon is feasible. For clinical N1 patients, identification and preservation of lymphatics of upper arm to prevent lymphedema is safe. But for patients with clinical N2 or advanced stage, the safety of lymphatics of upper arm is not sure yet. |
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