Clinical Study On Exploring New Axillary Region In Sentinel Lymph Node Biopsy Of Breast Cancer

Breast cancer is the most common malignant tumor in women,and surgery is always the main treatment for it.Surgery for breast tumors involves the treatment of primary breast tumors and axillary.About the treatment of axillary,at the beginning,Axillary Lymph Node Dissection（ALND）is a standard procedure for axillary treatment;then,Sentinel Lymph Node Biopsy（SLNB）became the standard surgical procedure for patients whose axillary nodes are negative in clinic.To reduce the incidence of Breast Cancer-related Lymphedema（BCRL）,Axillary Reverse Mapping（ARM）,a new procedure is applied in the clinic.All of the surgeries are used to achieve surgical precision treatment.BCRL is the most common postoperative complication after ALND.Since SLNB is applied in clinic,some ALND have been replaced by SLNB,which greatly reduced the incidence of BCRL,but the datas showed that patients who just operated with SLNB also suffered with BCRL.ARM further reduces the incidence of BRCL.Current researches show that the ARM lymph node in the region between the axillary vein and the Intercostal Brachial Nerve（ICBN）.However,studies have shown that ICBN has large individual differences,anatomical locations are not fixed,and the morphology is different.ObjectiveCompare the staining sentinel lymph node tracing technique with the fluorescence method for retrograde tracing of upper extremity lymph nodes,and to explore the application of ARM in breast cancer SLNB.Patient data were collected,and the anatomical location and anatomical morphology of ICBN were analyzed through specific experimental data to accurately locate the partitions of SLN and ARM lymph nodes.MethodsRetrospective analysis of clinical datas of 35 patients with T_1-2N₀M₀ breast cancer who are admitted to the Department of Breast Surgery in Tianjin Central Obstetrics and Gynecology Hospital from June 2017 to June 2018,then,make statistical analysis of the data.ResultsAll the 35 patients were female,with an average age of（53.34±12.105）years.All patients underwent SLNB.Intraoperative situation:2 cases of SLN with frozen return with clear metastases,then,underwent ALND and were excluded when analyzing data;the remaining 33 cases of SLN frozen return did not clear metastatic cancer.The ICBN of 3 patients was located 0-2.0 cm（9.09%）from the iliac vein.The ICBN of 27 patients was located 2.0-4.0 cm（81.82%）from the iliac vein.The ICBN of 3 patients was located more than 4.0 cm（9.09%）from the iliac vein.In the0-2 cm area,33 patients did not find SLN and overlapping lymph nodes,and 5patients found 2,2,2,1 and 1 ARM lymph nodes respectively;33 patients in the 2-4cm area SLN was found,and 4 patients each found a coincident lymph node;no ARM lymph nodes and overlapping lymph nodes were found in the>4 cm region,and 3 patients found 2,2,and 1 SLN,respectively.Conclusions1.ICBN individuals vary widely,vary in body shape,and vary in distance from the lower edge of the iliac vein.2.The axillary region below the iliac vein was divided into three regions:ARM region（0-2.0cm）-the distribution of ARM lymph nodes in this region is concentrated,there may be a small amount of SLN and Coincident lymph nodes;SLN region（2.0-4.0cm）-The SLN distribution in this area is concentrated,with a small number of ARM lymph nodes and Coincident lymph nodes;outpost region of SLN（>4.0cm）-there is a small amount of SLN distribution in this area,no ARM lymph node and Coincident lymph nodes.3.The position 2.0 cm from the lower edge of the iliac vein can be used as the boundary between the ARM lymph node and the SLN.4.There is a coincidence rate between SLN and ARM lymph nodes.