| Background: For a century,Axillary Lymph Node Dissection(ALND)has been the standard surgical procedure for breast cancer.In recent years,Z0011 trial has shown that breast cancer patients with 1 or 2 positive sentinel lymph nodes undergoing breast conserving surgery were safe without ALND,But there are still some controversy.Then TAXIS clinical trial start in 2018,The main objective of this trial is to test in clinically node-positive breast cancer,treatment with Tailored Axillary Surgery(TAS)and axillary radiotherapy is non-inferior to ALND in terms of disease-free survival.Tailored Axillary Surgery not only remove all the sentinel nodes,all palpably suspicious nodes are require to remove.Palpably suspicious nodes defined as either hardened or irregular or very large or a combination thereof,are removed.Objective: Based on the concept of TAS in the TAXIS trial,hard,enlarged and irregular lymph nodes are palpated during sentinel lymph node biopsy.We designed a preliminary trial to test whether TAS performed by intraoperative palpation has a better ability of positive lymph node clearance,whether the axillary tumor load of patients with axillary bed positive breast cancer can be reduced to negative or low load,and to evaluate whether TAS surgery can be applied in clinical practice.Methods: Prospective collection of 76 cases of breast cancer patients in The First Affiliated Hospital of Guangxi Medical University in July 2019 to January 2020.All patients meet the criteria clinical N1-N2 and confirmed by pathology,it would performed ALND if SLN is positive.Evaluation of the levels I–III by palpation is routine during the TAS,black stained and fluorescent lymph nodes are regarded as SLN(in group 1),others lymph node were considered as non-Sentinel Lymph Node(n SLN),palpation suspicious positive lymph nodes(defined as palpated hard or enlarged lymph nodes)in group 2,and the palpation negative lymph nodes were in group 3.Recorded the number of all lymph nodes and the number of pathologic positive lymph nodes in each group.The main observation index was the clinical palpation negative but pathologically positive lymph nodes in group 3.According to the residual pathological positive lymph nodes in group3,divided patients into three groups:axillary tumor negative(0),axillary tumor low load(1-2)and axillary tumor positive(> 2).The number of positive cases of axillary tumor after TAS operation was observed,and the feasibility of TAS was evaluated by this index.Results : 1.A total number of 1303 lymph nodes were detected in 76 cases,of which 481 were pathologically positive.158 positive lymph nodes were in group 1,the pathological positive rate was 56.6%(158/279),293 positive lymph nodes were in group 2,the pathological positive rate was 65.4%(293/448),and 30 positive lymph nodes were in group 3,and the pathological positive rate was 5.2%(30/576).TAS is to remove group 1 and group 2 lymph nodes,a total of 451 positive lymph nodes can be identified and removed by sentinel lymph node biopsy and clinical palpation,that is,the pathological positive lymph node recognition rate of TAS operation is 93.8%(451/481).In group 3,there were 576 unresectable lymph nodes in TAS,and the median number of lymph nodes reserved in 76 cases were 8(5,10).2.76 cases were divided into two groups according to the pathologically lymph nodes status by group 3.Analyzed the influencing factors between TAS residual positive lymph nodes and clinicopathological.The results showed that the number of positive SLN > 2 was more likely to develop TAS residual positive lymph nodes than the number of positive SLN≤ 2(P < 0.05).There was no correlation between age,menstrual status,ER,PR,HER-2,histological grade,vascular invasion,clinical stage,tumor location with residual positive lymph nodes in TAS.3.The lymph nodes in group 1 and group 2 were removed by TAS,there were 59 cases negative lymph node pathology in group 3,and 17 cases with residual positive lymph nodes in group 3.Among 17 cases with residual positive lymph nodes in group 3,15 cases had 1-2 residual positive lymph nodes and 2cases had more than 2 positive lymph nodes.TAS can convert 77.6%(59/ 76)cases of axillary clinically positive breast cancer patients to axillary tumor negative,19.8%(15/ 76)cases for axillary tumor low load,and 2.6%(2/76)cases for axillary tumor positive.TAS can reduce the tumor load of 97.4% of clinical axillary positive breast cancer patients to no tumor load or low load.Conclusion: 1.Intraoperative palpation Tailored Axillary Surgery has a high pathological positive lymph node recognition rate.2.Patients with more than 2 positive sentinel lymph nodes were more likely to develop residual positive sentinel lymph nodes than patients with less than 2positive sentinel lymph nodes during TAS.3.Tailored Axillary Surgery can transform of most clinical axillary positive breast cancer patients to axillary pathological state of no tumor load or low load,TAS is expected to be used in clinical practice. |
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