切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 50 -54. doi: 10.3877/cma.j.issn.1674-0807.2021.01.010

所属专题: 文献

综述

上肢淋巴系统功能保护在乳腺癌腋窝淋巴结清扫中的应用
袁芊芊1, 吴高松1,()   
  1. 1. 430071 武汉大学中南医院甲乳外科
  • 收稿日期:2020-08-24 出版日期:2021-02-01
  • 通信作者: 吴高松
  • 基金资助:
    武汉大学中南医院疑难病症诊治能力提升工程(肿瘤学)注册临床项目(ZLYNXM202014)

Function protection of upper extremity lymphatic system in axillary lymph node dissection for breast cancer

Qianqian Yuan1, Gaosong Wu1()   

  • Received:2020-08-24 Published:2021-02-01
  • Corresponding author: Gaosong Wu
引用本文:

袁芊芊, 吴高松. 上肢淋巴系统功能保护在乳腺癌腋窝淋巴结清扫中的应用[J]. 中华乳腺病杂志(电子版), 2021, 15(01): 50-54.

Qianqian Yuan, Gaosong Wu. Function protection of upper extremity lymphatic system in axillary lymph node dissection for breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(01): 50-54.

腋窝淋巴结清扫(ALND)是腋窝淋巴结阳性乳腺癌患者的标准治疗,用于腋窝局部控制、淋巴结分期、辅助治疗方案制定及预后评估,常见并发症包括上肢淋巴水肿、肩关节功能障碍、疼痛、麻木、乏力等,其中乳腺癌相关上肢淋巴水肿是非常困扰患者的并发症,与ALND破坏了上肢淋巴引流有关。基于上肢淋巴引流与乳腺淋巴引流互相独立的假说,腋窝逆向示踪(ARM)技术被用于ALND术中识别并保护上肢淋巴系统,从而预防或减轻水肿。但ARM技术在有效性和肿瘤安全性上仍有争议。近年来,高级别循证医学证据的前瞻性临床试验结果相继发表,证实了ARM技术的有效性,部分解决了肿瘤安全性问题。笔者总结了ARM技术在乳腺癌腋窝处理中的研究进展,为ARM技术的临床实践提供参考与借鉴。

表1 应用不同示踪方法的腋窝逆向淋巴示踪术的相关参数
作者 示踪方法 上肢淋巴结识别率[%(n/N)] 上肢淋巴结识别数目(枚) 前哨淋巴结与上肢淋巴结的重合率[%(n/N)] 上肢淋巴结转移率[%(n/N)] 术后淋巴水肿率a[%(n/N)]
Thompson等[8] 蓝染料 11/18b - 0 0 -
Nos等[9] 蓝染料 71.4(15/21) 1.7(1~3) - 14.3(3/21) -
Gennaro等[21] 同位素 75(45/60) - - - 8.9(4/45)
Nos等[22] 蓝染料+同位素 91.3(21/23) 1.7(1~3) - 14.3(3/21) -
Noguchi等[24] 荧光染料 7/8b 2.7(1~7) 2/12b 3/7b -
Britton等[26] 同位素 15/15b - 2/15b - -
Tausch等[27] 蓝染料+同位素 78.3(112/143) - - 25.5(14/55) -
Yue等[28] 蓝染料+同位素 93.5(129/138) 1.3 - 8.5(11/129) 5.9(7/118)
Yuan等[29] 蓝染料+荧光染料 81.0(558/689) - - - 3.3(18/543)
Noguchi等[30] 荧光染料 85.3(29/34) 5.3(1~7) - 37.9(11/29) -
Ikeda等[31] 荧光染料 80.0(48/60) 1.6±0.9 - 24(6/25) -
Ikeda等[32] 荧光染料 81.6(80/98) 1.6±0.9 - 22.4(17/76) 1/4b
Faisal等[33] 荧光染料 83.3(20/24) 2.25(1~3) - 0/4b 4.2(1/24)
Ma等[34] 荧光染料 65.9(29/44) 4.1(1~12) 11.4(5/44) 15.9(7/44) -
Boneti等[35] 蓝染料 42.7(56/131) - 3.9(5/128) 0 0(0/131)
Casabona等[36] 蓝染料 8/9b 1(0~3) 0 0 0/9b
Ponzone等[37] 蓝染料 55.1(27/49) - - 11.1(3/27) -
Bedrosian等[38] 蓝染料 50.0(15/30) - - 2/11b -
Deng等[39] 蓝染料 - - 8.7(6/69) 8.7(6/69) -
Rubio等[40] 蓝染料 83.3(30/36) - 2/15b 13.3(4/30) -
Gobardhan等[41] 蓝染料 90.3(84/93) - - 22(11/50) -
Han等[42] 蓝染料 83.5(76/91) 1.4±0.6 7.2(7/97) 2/17b 0 (0/70)
Connor等[43] 蓝染料 53.8(114/212) - 19.3(22/114) 2.7(1/37) -
Schunemann等[44] 蓝染料 88.9(40/45) 1.9 - 25(10/40) -
Beek等[45] 蓝染料 90.5(19/21) 1.58(1~4) - 38.1(8/21) -
Ngui等[46] 蓝染料 77.0(67/87) 1.16(0.75-1.57) 9.4(3/32) 26.9(18/67) -
Tummel等[47] 蓝染料 71.8(153/213) - 5.6(12/213) 4.5(2/44) -
Beek等[48] 蓝染料 79.2(38/48) 1.03(1~2) - 2.9(1/35) 22.9(8/35)
[1]
中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志,2019, 29(8):609-680.
[2]
Helyer LK, Varnic M, Le LW, et al. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients[J]. Breast J, 2010,16(1):48-54.
[3]
Disipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis [J]. Lancet Oncol, 2013,14(6):500-515.
[4]
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial[J]. J Natl Cancer Inst, 2006,98(9):599-609.
[5]
Gross JP, Whelan TJ, Parulekar WR, et al. Development and validation of a nomogram to predict lymphedema after axillary surgery and radiation therapy in women with breast cancer from the NCIC CTG MA.20 randomized trial[J]. Int J Radiat Oncol, 2019,105(1):165-173.
[6]
Cariati M, Bains SK, Grootendorst MR, et al. Adjuvant taxanes and the development of breast cancer-related arm lymphoedema[J]. Br J Surg, 2015, 102(9):1071-1078.
[7]
Nguyen TT, Hoskin TL, Habermann EB, et al. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study[J]. Ann Surg Oncol, 2017, 24(10):2972-2980.
[8]
Thompson M, Korourian S, Henry-Tillman R, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation[J]. Ann Surg Oncol, 2007, 14(6):1890-1895.
[9]
Nos C, Lesieur B, Clough KB, et al. Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection[J]. Ann Surg Oncol, 2007, 14(9):2490-2496.
[10]
贺青卿,岳涛,庄大勇. 乳腺癌术中腋窝逆向淋巴示踪研究进展[J]. 中华内分泌外科杂志,2014,8(2):127-129.
[11]
王璐,许雪宁,朱妍慧,等. 腋窝逆向淋巴结示踪术在乳腺癌患者选择性腋窝淋巴结清扫中的应用[J/CD]. 中华乳腺病杂志(电子版), 2017,11(6):325-330.
[12]
李琳,吴炅. 腋窝逆向淋巴示踪[J]. 外科理论与实践,2013,18(4):400-404.
[13]
刘媛,陆云飞. 腋窝逆向淋巴示踪的临床实践及争议[J/CD]. 中华乳腺病杂志(电子版), 2017,11(6):365-368.
[14]
岳涛,庄大勇,贺青卿,等. 腋窝逆向淋巴示踪预防乳腺癌患者上肢淋巴水肿的研究[J/CD]. 中华乳腺病杂志(电子版), 2014,8(2):92-98.
[15]
贺青卿,朱见,庄大勇,等. 腋窝逆向淋巴示踪预防乳腺癌术后上肢水肿[J]. 国际外科学杂志,2013,40(3):209-210.
[16]
Boughey JC, Suman VJ, Mittendorf EA, et al. Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (Alliance)[J]. Ann Surg, 2015,261(3):547-552.
[17]
Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial[J]. Lancet Oncol, 2014,15(12):1303-1310.
[18]
Sávolt Á, Péley G, Polgár C, et al. Eight-year follow up result of the OTOASOR trial: the optimal treatment of the axilla-surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer[J]. Eur J Surg Oncol, 2017,43(4):672-679.
[19]
Boughey JC. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer[J]. JAMA, 2013,310(14):1455.
[20]
Beek MA, Gobardhan PD, Schoenmaeckers EJ, et al. Axillary reverse mapping in axillary surgery for breast cancer: an update of the current status[J]. Breast Cancer Res Treat, 2016,158(3):421-432.
[21]
Gennaro M, Maccauro M, Sigari C, et al. Selective axillary dissection after axillary reverse mapping to prevent breast-cancer-related lymphoedema[J]. Eur J Surg Oncol, 2013,39(12):1341-1345.
[22]
Nos C, Kaufmann G, Clough KB, et al. Combined axillary reverse mapping (ARM) technique for breast cancer patients requiring axillary dissection[J]. Ann Surg Oncol, 2008,15(9):2550-2555.
[23]
Britton TB, Solanki CK, Pinder SE, et al. Lymphatic drainage pathways of the breast and the upper limb[J]. Nucl Med Commun, 2009,30(6):427-430.
[24]
Noguchi M, Yokoi M, Nakano Y. Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer[J]. J Surg Oncol, 2010,101(3):217-221.
[25]
Suami H, Taylor GI, Pan W. The lymphatic territories of the upper limb: anatomical study and clinical implications[J]. Plast Reconstr Surg, 2007,119(6):1813-1822.
[26]
Britton TB, Solanki CK, Pinder SE, et al. Lymphatic drainage pathways of the breast and the upper limb[J]. Nucl Med Commun, 2009,30(6):427-430.
[27]
Tausch C, Baege A, Dietrich D, et al. Can axillary reverse mapping avoid lymphedema in node positive breast cancer patients?[J]. Eur J Surg Oncol, 2013,39(8):880-886.
[28]
Yue T, Zhuang D, Zhou P, et al. A prospective study to assess the feasibility of axillary reverse mapping and evaluate its effect on preventing lymphedema in breast cancer patients[J]. Clin Breast Cancer, 2015,15(4):301-306.
[29]
Yuan Q, Wu G, Xiao S, et al. Identification and preservation of arm lymphatic system in axillary dissection for breast cancer to reduce arm lymphedema events: a randomized clinical trial[J]. Ann Surg Oncol, 2019,26(11):3446-3454.
[30]
Noguchi M, Noguchi M, Nakano Y, et al. Axillary reverse mapping using a fluorescence imaging system in breast cancer[J]. J Surg Oncol, 2012,105(3):229-234.
[31]
Ikeda K, Ogawa Y, Komatsu H, et al. Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients[J]. World J Surg Oncol, 2012,10:233.
[32]
Ikeda K, Ogawa Y, Kajino C, et al. The influence of axillary reverse mapping related factors on lymphedema in breast cancer patients[J]. Eur J Surg Oncol, 2014,40(7):818-823.
[33]
Faisal M, Sayed MG, Antonious K, et al. Prevention of lymphedema via axillary reverse mapping for arm lymph-node preservation following breast cancer surgery: a randomized controlled trial[J]. Patient Saf Surg, 2019,13:35.
[34]
Ma X, Wen S, Liu B, et al. Relationship between upper extremity lymphatic drainage and sentinel lymph nodes in patients with breast cancer[J]. J Oncol, 2019, 2019: 8 637 895.
[35]
Boneti C, Korourian S, Bland K, et al. Axillary reverse mapping: mapping and preserving arm lymphatics may be important in preventing lymphedema during sentinel lymph node biopsy[J]. J Am Coll Surg, 2008,206(5):1038-1042.
[36]
Casabona F, Bogliolo S, Valenzano Menada M, et al. Feasibility of axillary reverse mapping during sentinel lymph node biopsy in breast cancer patients[J]. Ann Surg Oncol, 2009,16(9):2459-2463.
[37]
Ponzone R, Cont NT, Maggiorotto F, et al. Extensive nodal disease may impair axillary reverse mapping in patients with breast cancer[J]. J Clin Oncol, 2009,27(33):5547-5551.
[38]
Bedrosian I, Babiera GV, Mittendorf EA, et al. A phase I study to assess the feasibility and oncologic safety of axillary reverse mapping in breast cancer patients[J]. Cancer, 2010, 116(11):2543-2548.
[39]
Deng H, Chen L, Jia W, et al. Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients[J]. J Cancer Res Clin, 2011,137(12):1869-1874.
[40]
Rubio IT, Cebrecos I, Peg V, et al. Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer[J]. J Surg Oncol, 2012,106(1):89-93.
[41]
Gobardhan PD, Wijsman JH, van Dalen T, et al. ARM: axillary reverse mapping - The need for selection of patients [J]. Eur J Surg Oncol, 2012,38(8):657-661.
[42]
Han JW, Seo YJ, Choi JE, et al. The efficacy of arm node preserving surgery using axillary reverse mapping for preventing lymphedema in patients with breast cancer[J]. J Breast Cancer, 2012,15(1):91.
[43]
Connor C, Mcginness M, Mammen J, et al. Axillary reverse mapping: a prospective study in women with clinically node negative and node positive breast cancer[J]. Ann Surg Oncol, 2013,20(10):3303-3307.
[44]
Schunemann E Jr, Dória MT, Silvestre JB, et al. Prospective study evaluating oncological safety of axillary reverse mapping[J]. Ann Surg Oncol, 2014,21(7):2197-2202.
[45]
Beek MA, Gobardhan PD, Klompenhouwer EG, et al. Axillary reverse mapping (ARM) in clinically node positive breast cancer patients[J]. Eur J Surg Oncol, 2015,41(1):59-63.
[46]
Ngui NK, French J, Kilby CJ, et al. Axillary reverse mapping in patients with breast cancer: is it oncologically safe?[J]. J Surg Oncol, 2016,113(7):726-731.
[47]
Tummel E, Ochoa D, Korourian S, et al. Does axillary reverse mapping prevent lymphedema after lymphadenectomy?[J]. Ann Surg, 2017,265(5):987-992.
[48]
Beek MA, Gobardhan PD, Klompenhouwer EG, et al. A patient- and assessor-blinded randomized controlled trial of axillary reverse mapping (ARM) in patients with early breast cancer[J]. Eur J Surg Oncol, 2020,46(1):59-64.
[49]
Clough KB, Nasr R, Nos C, et al. New anatomical classification of the axilla with implications for sentinel node biopsy[J]. Br J Surg, 2010,97(11):1659-1665.
[50]
Nos C, Clough KB, Bonnier P, et al. Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection [J]. Eur J Surg Oncol, 2016, 42(12):1827-1833.
[51]
Suami H, Pan W, Mann GB, et al. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: A human cadaver study[J]. Ann Surg Oncol, 2008,15(3):863-871.
[52]
Pavlista D, Eliska O. Analysis of direct oil contrast lymphography of upper limb lymphatics traversing the axilla - a lesson from the past - contribution to the concept of axillary reverse mapping[J]. Eur J Surg Oncol, 2012,38(5):390-394.
[53]
Suami H, Pan W, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver[J]. Plast Reconstr Surg, 2007,120(4):982-991.
[54]
Yuan Q, Wu G. ASO author reflections: Identification and preservation of axillary lymphatic system[J]. Ann Surg Oncol, 2019,26(S3):823.
[55]
Ochoa DA. Axillary lymphatic evaluation: A solution to a complex problem[J]. Ann Surg Oncol, 2019,26(11):3413-3414.
[56]
Tashiro K, Yamashita S, Koshima I, et al. Visualization of accessory lymphatic pathways in secondary upper extremity lymphedema using indocyanine green lymphography [J]. Ann Plast Surg, 2017, 79(4):393-396.
[57]
Noguchi M, Noguchi M, Ohno Y, et al. Feasibility study of axillary reverse mapping for patients with clinically node-negative breast cancer[J]. Eur J Surg Oncol, 2016,42(5):650-656.
[58]
Beek MA, Tetteroo E, Luiten EJT, et al. Clinical impact of breast MRI with regard to axillary reverse mapping in clinically node positive breast cancer patients following neo-adjuvant chemotherapy[J]. Eur J Surg Oncol, 2016, 42(5):672-678.
[1] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(08): 844-848.
[2] 邵华, 那子悦, 荆慧, 李博, 王秋程, 程文. 术前经皮超声造影对乳腺癌腋窝前哨淋巴结转移及负荷的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 849-853.
[3] 孙帼, 谢迎东, 徐超丽, 杨斌. 超声联合临床特征的列线图模型预测甲状腺乳头状癌淋巴结转移的价值[J]. 中华医学超声杂志(电子版), 2023, 20(07): 734-742.
[4] 唐玮, 何融泉, 黄素宁. 深度学习在乳腺癌影像诊疗和预后预测中的应用[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 323-328.
[5] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[6] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[7] 施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 353-361.
[8] 伍秋苑, 陈佩贤, 邓裕华, 何添成, 周丹. 肠道微生物在乳腺癌中的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 362-365.
[9] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[10] 燕速, 霍博文, 徐惠宁. 4K荧光腹腔镜扩大右半结肠CME+D3根治术及No.206、No.204组淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 14-14.
[11] 樊丽超, 郭瑾瑛, 陈鑫. 野生型RET与RET/PTC融合基因检测对甲状腺乳头状癌中央区淋巴结清扫的指导意义[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 631-635.
[12] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[13] 李智铭, 郭晨明, 庄晓晨, 候雪琴, 高军喜. 早期乳腺癌超声造影定性及定量指标的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 639-643.
[14] 徐成, 王璐璐, 王少华. 洗脱液甲状腺球蛋白在甲状腺乳头状癌转移淋巴结中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 701-704.
[15] 袁育韬, 邢金琳, 谢克飞, 殷凯. CT征象及BRAFV600E基因突变与甲状腺乳头状癌中央区淋巴结转移的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 611-614.
阅读次数
全文


摘要