Background: Axillary reverse mapping (ARM) nodes are involved in a significant proportion of clinically node-positive (cN+) breast cancer patients. However, neoadjuvant chemotherapy (NAC) is effective at decreasing the incidence of nodal metastases in cN+ patients. Patients and methods: One hundred forty-five cN+ patients with confirmed nodal involvement on ultrasound-guided fine needle aspiration cytology were enrolled in this study: one group underwent axillary lymph node dissection (ALND) without NAC (upfront surgery group), and the other group underwent ALND following NAC (NAC group). The patients underwent18F-FDG-positron emission tomography/computed tomography (18F-FDG-PET/CT) before surgery, as well as an ARM procedure during ALND. Results: the rates of involvement of ARM nodes in the NAC group were significantly lower than those of the upfront surgery group (36.6% vs. 62.2%,p< 0.01). Notably, involvement was significantly decreased after NAC in non-luminal-type tumors as compared to the luminal-type (18.4% vs. 48.5%:p< 0.01). Moreover, there was a significant difference in ARM node involvement after NAC between patients with or without axillary uptake of18F-FDG (61.5% vs. 32.5%:p< 0.01). Conclusions: NAC significantly decreased the risk of ARM node metastases in cN+ patients, but18F-FDG-PET/CT was not suitable to detect residual metastatic disease of the axilla after NAC.
背景：腋窝反向绘图（ARM）淋巴结在临床淋巴结阳性（cN+）乳腺癌患者中受累比例显著。然而，新辅助化疗（NAC）能有效降低cN+患者淋巴结转移的发生率。患者与方法：本研究纳入145例经超声引导细针穿刺细胞学确诊淋巴结受累的cN+患者：一组未接受NAC直接行腋窝淋巴结清扫术（ALND）（直接手术组），另一组在NAC后接受ALND（NAC组）。所有患者术前均接受18F-FDG正电子发射断层扫描/计算机断层扫描（18F-FDG-PET/CT），并在ALND术中实施ARM操作。结果：NAC组ARM淋巴结受累率显著低于直接手术组（36.6% vs. 62.2%，p<0.01）。值得注意的是，非管腔型肿瘤经NAC后淋巴结受累率较管腔型显著降低（18.4% vs. 48.5%，p<0.01）。此外，18F-FDG在腋窝有无摄取的患者经NAC后ARM淋巴结受累率存在显著差异（61.5% vs. 32.5%，p<0.01）。结论：NAC显著降低了cN+患者ARM淋巴结转移风险，但18F-FDG-PET/CT不适用于检测NAC后腋窝残留转移病灶。
Axillary Reverse Mapping in Clinically Node-Positive Breast Cancer Patients
肿瘤(癌症)患者之家