Does Axillary Reverse Mapping Prevent Lymphedema After Lymphadenectomy?
Does Axillary Reverse Mapping Prevent Lymphedema After Lymphadenectomy?
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DOI：
10.1097/sla.0000000000001778
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发表时间：
2017-05-01
影响因子：
9
通讯作者：
Klimberg, V. Suzanne
中科院分区：
文献类型：
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作者：
Tummel, Evan;Ochoa, Daniela;Klimberg, V. Suzanne
背景资料：我们假设前哨淋巴结活检（SLNB）和腋窝淋巴结清扫（ALND）中令人不安的水肿发生率可能是由于腋窝内手臂淋巴引流的未被识别的脆弱变化。腋窝反向映射（ARM）有利于识别和避免腋窝内的手臂神经纤维化，其使用可能会减少hedema.Methods：该机构审查委员会批准的研究，从2007年6月至2013年12月涉及患者接受SLNB与或不ALND，或ALND单独。乳晕下注射锝用于乳房SLN的定位，并在同侧上臂注射异硫蓝染料（5 mL）用于非乳房淋巴结的定位。数据收集的识别和保存手臂martichatics，交叉率，蓝色淋巴结转移，腋窝复发，和lymphedema作为测量体积displacement.Results：共654例患者进行了前瞻性的685 ARM程序与SLNB和/或ALND。SLNB和ALND的客观水肿发生率分别为0.8%和6.5%，中位随访时间为26个月。SLNB和ALND的蓝色荧光检出率分别为29.2%（138/472）和71.8%（153/213）。SLNB和ALND的交叉率分别为3.8%（18/472）和5.6%（12/213）。蓝结转移率为4.5%（2/44）。腋窝复发率分别为0.2%和1.4%SLNB和ALND，force.Conclusions：ARM允许经常识别手臂的腋窝，这将是在常规手术中横断。非交叉淋巴结转移率和腋窝复发率低。与公认的标准相比，使用ARM可显著降低淋巴水肿发生率。
Background: We hypothesized that disconcerting lymphedema rates in both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may be because of unrecognized vunerable variations in arm lymphatic drainage within the axilla. Axillary reverse mapping (ARM) facilitates identification and avoidance of arm lymphatics within the axilla and its use may reduce lymphedema.Methods: This institutional review board-approved study from June 2007 to December 2013 involved patients undergoing SLNB with or without ALND, or ALND alone. Technetium is injected subareolarly for localization of the breast SLN and isosulfan blue dye (5 mL) is injected in the ipsilateral upper arm for localization of nonbreast lymphatics. Data were collected on identification and preservation of arm lymphatics, crossover rates, blue node metastases, axillary recurrence, and lymphedema as measured by volume displacement.Results: A total of 654 patients prospectively underwent 685 ARM procedures with a SLNB and/or ALND. Objective lymphedema rates for SLNB and ALND were 0.8% and 6.5% respectively, with 26-month median follow up. Blue lymphatics were identified in 29.2% (138/472) of SLNB and 71.8% (153/213) of ALND. Crossover was seen in 3.8% (18/472) of SLNB and 5.6% (12/213) of ALND. Blue node metastases rate was 4.5% (2/44). Axillary recurrence rate was 0.2% and 1.4% for SLNB and ALND, respectively.Conclusions: ARM allows frequent identification of arm lymphatics in the axilla, which would have been transected during routine surgery. Rates of metastases in noncrossover nodes and axillary recurrences are low. Lymphedema rates are dramatically reduced using ARM when compared with accepted standards.