The Clinical Study On Sentinel Lymph Node Biopsy Replace Axillary Lymph Node Dissection In Patients With Early-stage Breast Cancer

ObjectiveCompare ill side upper limb function in early postoperative and long-term state of lifeafter surgery between SLNB and ALND for early-stage breast cancer patients withsentinel lymph node-negative. Study the benefit、security and feasibility of theoperation that simple SLNB instead of ALND.MethodsIn patients with early breast cancer surgery used methylene blue to locate, look forsentinel lymph node. After intraoperative rapid frozen pathological examination，selected the case with sentinel lymph node Sentinel lymph node-negative into the study.Choose40cases, were randomly divided into SLNB group (n=20) and ALND group(n=20). SLNB group: Don’t clean the axillary lymph nodes, Breast conservingsurgery or Total Mastectomy, Postoperative adjuvant therapy(Adjuvant chemotherapy,Receptor-positive patients with endocrine therapy, Patients with breast conservingsurgery give the breast radiotherapy). ALND group: Clean the axillary lymph nodes oftheⅠ and Ⅱ group,Breast conserving surgery or Total Mastectomy, Postoperativeadjuvant therapy (Adjuvant chemotherapy, Receptor-positive patients with endocrinetherapy, Patients with breast conserving surgery give the breast radiotherapy). In theprocess of treatment, observed, measured of upper extremities function condition oftwo groups of patients. After the treatment, all closely followed up. Contrasted theincidence of shoulder dysfunction(Neer shoulder joint function score and outreachangles of shoulder joint) and upper extremity lymph edema(upper arm circumferences) in early postoperative and overall survival, disease-free survival and recurrence rate ofill side axillary lymph node in postoperative long-term.ResultsIll side upper limb function in early postoperative:①I n patients with SLNB, the circumferences ofill side upper arm in one, two, andfour weeks after operation were similar to those before operation (P=0.067, P=0.212,and P=0.698, respectively). While, in patients with ALND, the circumferences ofupper arm in one or two weeks after operation were significantly bigger than thosebefore operation (P=0.004, P=0.012, respectively), and the circumference in fourweeks after operation was similar to that before operation (P=0.204).②In patients with SLNB, theill side Neer shoulder joint function score in one and twoweeks after operation were smaller than those before operation (P=0.000, P=0.000,res-pectively), and the scores in four weeks after operation was similar to that beforeoperation (P=0.163).However, in patients with ALND, the scores in one, two or fourweeks after operation were smaller than those before operation (P=0.000, P=0.000,and P=0.000, respectively). Before operation, the ill side Neer shoulder joint functionscore and outreach angles of shoulder joint between patients with SLNB and ALNDwere both smaller (P=0.284, P=0.558, respectively). However, four weeks afteroperation,the scores and angles in patients with SLNB were both higher than thosewith ALND(P=0.000, P=0.000, respectively).Long-term state of life after surgery: followed for6months.①SLNB group of ill side upper limb lymphedema was not occurred, ALND group has4cases with ill side upper limb lymphedema, comparing the two groups wasstatistically difference (P=0.035）. In patients with SLNB, ill side upper armcircumferences after6months were close to that before operation (P=0.336). However,in patients with ALND, the circumferences after6months were bigger than that before operation (P=0.011). Six months after surgery, ill side upper arm circumferences inpatients with ALND were bigger than SLNB (P=0.037). However, before operation,the circumferences between patients with SLNB and ALND was smaller (P=0.934).②In patients with SLNB, there was no difference in six months and preoperativelevels in ill side Neer shoulder joint function score and outreach angles of ill sideshoulder joint (P=0.141, P=0.176, respectively). However, six months after surgery,the scores and angles in patients with ALND were much smaller than that beforeoperation (P=0.000, P=0.000, respectively). Six months after surgery, score andangles of SLNB group was obviously higher than ALND group (P=0.000, P=0.000,respectively). However, before operation, the score and angles between patients withSLNB and ALND were both smaller (P=0.284, P=0.558, respectively).③Were followed up for6months, SLNB group of20patients with ALND group weresurvival, tumor local recurrence and distant metastasis was not found, there were noswelling of axillary lymph nodes. SLNB and ALND group(with20patientsrespectively) were all survival, and no local recurrence or distant metastasis; axillaryintumescent lymph node was not found in ill side.Conclusion1. In early-stage breast cancer patients with Sentinel lymph node-negative, SLNBsubstitute ALND can reduce the incidence of shoulder dysfunction and upper extremitylymph edema in early postoperative and postoperative long-term (6months aftersurgery).2. In early-stage breast cancer patients with Sentinel lymph node-negative, SLNBsubstitute ALND was no adverse effect on overall survival, disease-free survival andrecurrence rate of ill side axillary lymph node. So the method is safe and feasible.（Butmore long-term result need further follow-up.）...