Clinical Research On Axillary Lymph Node Metastases Of Breast Cancer

Background: Lymphatic way is the main metastasis pathway of the breast cancer. The axillary lymph node dissection also a very important part of the surgical therapy. Through the ALND,we can know whether the axillary lymph nodes have been involved, that is a part of evaluating the staging of disease. We also can know about the prograsis of the illness and make the post-operational therapy plan. The ALND removing the lymph node that might have been involved can reduce the chance of local relapse and radiation therapy. But ALND also bring us a lot of questions such as the edema of the upper extremity after operation , lymphangitis , limbs motor dysfunction , et al. Some research report that the total axillary lymph node dissection (TLND) cannot give a better effect to the non-lymph-node invasived breast cancer. Is it necessary to reserve the ALND and TLND ? And is there an auxiliary examination can tell us the condition of ALNM exactly ? At present , no independent method can solve the question above-mentioned. The clinician can do is just to evaluate the state of ALNM through physical examination and auxiliary examination. In a word , once we handle the rule of ALNM, we can make an easy and right output about the patients' disease. And we can give them an individualization-therapy to reduce the residual and complication of the ALND possibly.Objective: Exploring the rule of ALNM and discussing the relationship between ALNM with tumor size and location to guide the dissection range of breast cancer operation.patients and Method:A total of 201 patients with breast cancer enter the research during 04/2000-10/2007. Collect the pathologic data (the size and location of the tumor) of the patients and group the ALN intoⅠ,Ⅱ,Ⅲ, Rotter before the pathologic examination. The smaller pectoral muscle was used to delineate the different levels (first level : outside the smaller pectoral muscle which include the lateral group, central group, subscapularis group and part of vena axillaries lymph nodes ; second level :behind the smaller pectoral muscle ; third level :the deltopectoral lymph nodes which are inside the smaller pectoral also called infraclavicula group. IPN, interpectoral nodes whose location is between the greater pectoral muscle and the smaller pectoral muscle are incorporated into Rotter group , an independent level.Use the SPSS 13. 0 software for statistical analysis, and the method is X~2 test.Results:1. Among above 201 breast cancer patients , 104 patients (51. 74%) suffer ALNM. The metastasis ratio of patients by levelⅠ,Ⅱ,Ⅲdescend significantly(50. 25% vs 28. 46% vs 16.42%, p<0. 05). Totally 4526 lymph nodes were found in the research while 22. 5 per patient. The metastasis ratio of lymph node is different between the level II and levelⅢwhile has the same result between the level I and levelⅢ(18.85% vs14.92%; 18.81% vs 14.92%, p<0. 05);2. The ratio of skip metastasis is 2. 88%. One case has no level I involved but levelⅡ,Ⅲinvoled, and one case has level II involved only, and one case just has IPN involved;3. The bigger the tumor size , the higher the metastases ratio of total ALN, levelⅠ, levelⅡand levelⅢ(35. 00% vs 66. 27% vs 77.78%; 34. 00% vs 65.06% vs 77.78%; 16.00% vs 38.55% vs 50.00%; 8.00% vs 21.69% vs 38.89%, p<0. 05); 4. As for the metastases ratio of levelⅠ, levelⅡand levelⅢlymph node, among the tumors locating in inner, middle and outer bands of breast, there is no obvious statistically difference(55. 20% vs 47. 37% vs 44.74%; 54.40% vs 47.37 vs 42.11%; 30.40% vs 26.32% vs 23.68%; 17.60% vs 18.42% vs 10.53%, p>0.05);5. The discovery ratio of IPN is 18.41%, and the ratio of metastasis is 8.96%. The involved ratio of lymph node is 48. 57%. The size and location of the tumor are no matter with the discovery ratio (16.00% vs 20.48% vs 22.22%; 15.20% vs 21.05% vs 26.32%, p>0. 05), but as the tumor get bigger the metastasis ratio of IPN increase conspicuously(4.00% vs 12.05% vs 22.22%, p<0.05).Conclusion:1. More than half patients with breast cancer has ALNM.2. The metastasis rule : levelⅠ→levelⅡ→levelⅢcan be observed mostly through the research while the skip metastasis indeed exist.3. The tumor size is correlated with the ALNM while the location of tumor is not an important factor. When we get a big tumor, we should dissect the lymph node thoroughly.4. The involved IPN exist in patients with bigger tumor. We should dissect the pectoralis anadesma for routine just in case left the involved IPNs alone.5. The TLND is the only one way to get the message of ALNM exactly. It' s also a useful method to cure breast cancer and prevent relapsing.