A Clinical Study Of New Operation Method For Breast Cancer And Sentinel Lymph Node Examination

Objective: To design and clinically verify the feasibility of inverse lymph node dissection and compare the results of sentinel nodes dyed with methylene blue and those of inverse lymph node dissection of fossa axillary and subclavicular, at the same time,to investigate the practical strategies of breast conservation therapy.Method: Clinical and pathological relations of sentinel nodes dyed with methylene blue in 78 in-patient invasive ductal breast cancer cases admitted from Oct.2002 to Mar.2005 were compared. All the lymph nodes of drainage area were removed with inverse lymph node dissection method. 42 patients were received breast conservation therapy and the other 36 patients were received modified radical mastectomy. Samples (breast or lymph nodes) in 78 cases were examined pathologically. Pathological diagnoses and clinical data (age, tumor site, tumor size and lymph nodes) were comprehensively analyzed. Relative analyses were made for different breast cancers.Results: 9 in 42 patients received breast conservation therapy had lymph node metastases. 19 in 36 patients received mastectomy had lymph node metastases. 3 in 8 patients whose Axillary lymph nodes were methylene blue negatively-dyed, had saltatory blue-dyeing and were proofed metastatic. Discovering rate of sentinel nodes was 89.7%. There were no complications such as nerve and vessel damage in 78 cases. All of the patients have beenfollowed up from 3 to 29 months, without metastasis, recurrence, pain or lymphedema of upper extremeties.Conclusion: 1. Inverse lymph node dissection is feasible without limitations by age, breast conservation or mastectomy and tumor site. It is suitable for multiplicate kinds of operation aimed at conserving pectoral muscle or/and breast. This kind of operation can completely control all regional lymph nodes, which is hepfiil for doctors to determine comprehensive treatment for breast cancer patients. 2.Sentinel lymph nodes were examined using methylene blue dyeing, with discovering rate 89.7%(70/78), skip metastasis rate 3.8%(3/78). Inverse lymph node dissection can make up false negativeness and saltatory metastasis which may be missed by sentinel node biopsy. It is especially useful to breast conservation surgery. 3. Inverse lymph node dissection during breast cancer operation can completely conserve pectoral muscle, clearly show all axillary lymph nodes and is easily manipulated. This type of operation has not be seen before within homeland.