유방암 환자의 액와부 수술 중 상지에서 배액되는 림프 경로의 보존 = Preservation of Lymphatic Drainage of Arm during Axillary Procedure in Breast Cancer Patients

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study was to confirm the feasibility of the technique, the so called ‘‘axillary reverse mapping (ARM)’’, and to test the hypothesis that the arm lymphatics are never involved by the metastatic process of breast cancer. Methods: We reviewed the prospectively maintained database of 129 patients who underwent an operation for breast cancer. Blue dye was injected in the upper inner arm to identify the draining lymphatics or lymph nodes from the arm. During the axillary procedure, we found the ‘‘blue’’ ARM node and the ‘‘hot’’ sentinel lymph node (SLN). The histological results of the ARM nodes were compared with those of the other nodes harvested in SLN biopsy (SLNB) or axillary lymph node dissection (ALND). Results: The ARM nodes were identified in 78.3% (101/129) of the patients. The ARM nodes were identified in 71.6% (58/81) of the patients with SLNB and in 88.4% (38/43) of the patients with SLNB followed by ALND and in all cases with ALND. In 19 of the 96 SLNB cases, the ARM nodes were hot or the SLNs were blue (concordant case), yielding an 18.9% concordant rate between
the ARM node and the SLN. Among these 19 concordant cases, 7 ARM nodes contained metastasis (36.8%). But in the 77 non-concordant cases, only one ARM node was positive for metastasis (1.3%) in a heavily metastasized axilla. The ARM nodes were identified in all five ALND cases, and one ARM node was positive for metastasis. Conclusion: It is thought that lymphatic drainage from the arm can share common lymphatic channels in the axilla with lymphatic flow from breast, and these concordant ARM nodes may be involved by the metastatic process of breast cancer. However in the non-concordant cases, ARM nodes will be free from the danger of axillary dissection.

참고문헌 (Reference)

1 Leidenius M, "The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance" 92 : 23-31, 2005

2 Hama Y, "Simultaneous two-color spectral fluorescence lymphangiography with near infrared quantum dots to map two lymphatic flows from the breast and the upper extremity" 103 : 23-28, 2007

3 Giuliano AE, "Sentinel lymphadenectomy in breast cancer" 15 : 2345-2350, 1997

4 Carter CL, "Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases" 63 : 181-187, 1989

5 Blanchard DK, "Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer" 138 : 482-487, 2003

6 Mansel RE, "Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial" 98 : 599-609, 2006

7 Tasmuth T, "Pain and other symptoms during the first year after radical and conservative surgery for breast cancer" 74 : 2024-2031, 1996

8 Ro_nka_ R, "One-year morbidity after sentinel node biopsy and breast surgery" 14 : 28-36, 2005

9 Haid A, "Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation" 73 : 31-36, 2002

10 Schrenk P, "Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma" 88 : 608-614, 2000

11 Newman ML, "Lymphedema complicated by pain and psychological distress: a case with complex treatment needs" 12 : 376-379, 1996

12 Giuliano AE, "Lymphatic mapping and sentinel node biopsy in breast cancer" 277 : 791-792, 1997

13 Swenson KK, "Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer" 9 : 745-753, 2002

14 손병호, "Comparison of Early Postoperative Axillary Morbidity Following the Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection" 한국유방암학회 10 (10): 107-113, 2007

15 Soran A, "Breast cancer-related lymphedema: what are the significant predictors and how they affect the severity of lymphedema?" 12 : 536-543, 2006

16 Nos C, "Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection" 14 : 2490-2496, 2007

17 Ponzone R, "Axillary reverse mapping in breast cancer: can we spare what we find?" 15 : 390-391, 2008

18 Thompson M, "Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation" 14 : 1890-1895, 2007

19 Ivens D, "Assessment of morbidity from complete axillary dissection" 66 : 136-138, 1992