| Objective: In the female malignancies,breast cancer does serious harm to the health of the female.Lymphatic metastasis is the most important way of transferring.The accurate diagnosis of lymph node status has important significance of the tumor stage,treatment and prognosis of breast cancer.The purpose of this experiment is to study the relation between the level III lymph node metastasis and tumor size,histologic grading,clinical stage,the level I-II lymph node metastasis and prognosis.The result may guide the clinical diagnosis and treatment.Method:This study collects the datas of breast cancer patients whose clinical or imaging diagnosis of axillary lymph nodes are positive from April 2016 to February 2017.According to the dissection of axillary lymph nodes,these patients were divided into two groups,complete axillary lymph node dissection group(test group)and partial axillary lymph node dissection group(control group).The test group detected the total axillary lymph node including the third lymph nodes bying pulling the pectoralis major and minor pectoral muscles or splitting pectoralis major(Kodama Surgery).The control group used conventional modified radical mastectomy I to detect I-II lymph nodes(Auchincloss Surgery).The tumor and lymph nodes were continuously sliced and stained with hematoxylin-eosin and immunohistochemistry.Collect the information of the patients,surgery,postoperative pathology,postoperative complications,local recurrence and metastasis,survival data.Use SPSS17.0 to obtain data for statistical analysis.Different ways were carried out according to the different types of data,such as rank sum test,chi-square test,Logistic regression analysis.Set P < 0.05 regarded as statistically significant.Results:1.There were significant differences in the number of lymph node dissection between test group and the control group(23.77±2.06 vs19.40±1.60,P<0.05),the test group of lymph nodes was higher than that of control group.The lymph node positive rate was higher in the test group(20.48%,17.87%),but the number of positive lymph nodes had no significant difference(4.87±3.00 vs 3.47±1.83,P>0.05).2.The level III metastasis was higher in patients whose level I-II lymph node metastasis(38.1%).The rate of lymph node metastasis in level III group was higher in stage III breast cancer patients(72.7%).3.Logistic regression showed that the expression of Her-2 was related to level III lymph node metastasis(P<0.05).Age,menstrual status,ER and PR expression were not related to level III lymph node metastasis(P>0.05).4.The number of axillary lymph nodes metastasis in I-II group were significantly related to level III lymph node metastasis(P<0.05).Patients with N2 and N3 were more likely to develop third groups of lymph node metastases.Patients with a higher proportion of lymph nodes were more likely to have lymph node metastasis in the Level III lymph node.5.There was a significant difference in the operation time between the experimental group and the control group(P>0.05),the experimental group was significantly more than the control group,with an average of more than 10-20 min.,but there was no significant difference in the amount of intraoperative blood loss and the time of pulling out the drainage tube after surgery(P<0.05).6.There was no significant difference in the incidence of postoperative complications between the experimental group and the control group.7.Detection third lymph nodes may reduce the local recurrence rate,but the long-term survival status needs further observation.Conclusion: Detecting group lymph nodes including third lymph nodes who has risk factors of breast cancer may have certain clinical benefits.The dissection of third groups of lymph nodes can be considered in the breast cancer patients whose axillary lymph nodes are positive,especially with high risk factors of large tumor size(T3 and above),HER-2 positive,I-II group of lymph node metastasis.As long as we have certain skills and methods,the postoperative complications will not significantly increase. |
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