Patient-reported Upper Limb Function After Sentinel Lymph Node Biopsy for Breast Cancer: A Prospective Observational Study

IntroductionSentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in breast cancer. There is a lack of consistency in studies reporting on upper limb morbidity after SLNB. We present a prospective study evaluating upper limb function after SLNB using the validated quickDASH questionnaire.Materials and MethodsConsecutive patients who underwent wide local excision and SLNB were included in the study. Arm function was assessed using the quickDASH questionnaire at 3 time points – prior to surgery and 2 weeks and 3 months after SLNB. The scores obtained were labeled as A, B, and C respectively. The mean and median scores were compared using the paired t test and Wilcoxon signed rank test.ResultsNinety-nine patients met all inclusion criteria and were included in the final analysis. The mean A, B, and C scores were 8.46, 16.05, and 13.36. The median A, B, and C scores were 2.27, 7.5, and 4.54. There was a statistically significant difference between mean and median A and B scores, B and C scores, and A and C scores. A similar trend was observed in patients with better preoperative upper limb function. Patients with a higher body mass index had significantly worse B and C scores.ConclusionThere is a significant deterioration in upper limb function following SLNB. This improves at 3 months but does not reach baseline levels. Larger studies with long-term follow-up are required to establish the extent of upper limb functional morbidity and natural course of functional recovery after SLNB.     

血管内皮生长因子在乳腺癌中的表达及其与腋窝淋巴结转移的关系

目的:探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)在乳腺癌中的表达及其与腋窝淋巴结转移的关系.方法:应用链霉素抗生素蛋白--过氧化酶(strep tavidin-Peroxidase,S-P)免疫组化技术检测62例乳腺癌组织的VEGF表达.结果:VEGF在有腋窝淋巴结转移患者中阳性表达20例(62.5%),在无腋窝淋巴结转移患者中阳性表达2例(6.7%),两组比较有显著性差异(P＜0.01).肿瘤大小与VEGF的阳性表达呈密切正相关(P＜0.01).结论:VEGF表达的增高对乳腺癌腋窝淋巴结转移有促进作用,可作为衡量肿瘤转移的参考指标.     

Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer

Background Axillary lymph node dissection (ALND) is often associated with permanent arm side effects. Side effects after sentinel lymph node dissection (SLND) should be less common, because the surgery is less extensive. Methods The study compared side effects and interference with daily life between 169 women who underwent an SLND and 78 who underwent an ALND for breast cancer. Patients rated symptom severity and interference with daily life caused by pain, numbness, limitation of arm range of motion (ROM), and arm swelling at 1, 6, and 12 months after surgery by using the Measure of Arm Symptom Survery. Repeated-measures and regression analyses for each time period were used to determine associations between symptoms and dissection type. Results At 1 month, SLND patients reported less pain, numbness, limitation in ROM, and seromas than ALND patients. At 6 months, SLND patients had less pain, numbness, and arm swelling, and at 12 months, SLND patients had less numbness, arm swelling, and limitation in ROM than ALND patients. At 1 month, pain, numbness, and limitation in ROM interfered significantly more with daily life for ALND patients. At 6 and 12 months, only numbness interfered more with daily life for ALND patients. Conclusions SLND was associated with fewer side effects than ALND at all time points.     

Ultrasound-guided large needle core biopsy of the axilla

Purpose: To study the diagnostic yield and safety aspects of large needle core biopsy of pathologic lesions in the axillary region using a semi-automatic biopsy gun. Material and Methods: A series of 21 consecutive large needle core (14G, 2.1 mm) biopsies of the axilla was evaluated. The biopsies were performed under ultrasound guidance with one (n=13) or two (n=8) needle passes. The results were correlated to the clinical, mammographic, ultrasound and surgical histopathologic findings. Results: In 18 patients, specimens large enough for diagnosis were retrieved. In two patients the specimens were insufficient and non-diagnostic. In one patient with a non-malignant yield the result was false-negative. No neural or vascular injury occurred. Conclusion: The procedure might be safely employed in the diagnosis of ultrasonographically demonstrable lesions of the axilla, whenever specimens larger than those obtainable with a fine needle are desired.     

Axillary lymph node metastasis following resection of abdominal wall laparoscopic port site recurrence of gallbladder cancer

Abdominal wall port site recurrence of gallbladder cancer is well described in the literature in patients that have undergone laparoscopic cholecystectomy with the incidental finding of a gallbladder cancer. The etiology and consequences of this type of metastatic recurrence are unclear. This report describes two cases with the unique sequelae of the interval development of nodal metastases to the axillary lymph nodes following resection of an abdominal wall laparoscopic port site recurrence of gallbladder cancer. The first case involves a patient who developed an isolated left axillary lymph node metastasis approximately 10 months after undergoing resection of a left-sided abdominal wall port site recurrence for a T2 gallbladder cancer. The original tumor had been found at laparoscopic cholecystectomy and definitively treated surgically approximately 3 years earlier. The second case involves a patient who developed isolated nodal metastases to the right axillary lymph nodes approximately 4 months after undergoing resection of right-sided abdominal wall port site recurrence, segment 4/5 hepatic resection, and portal lymphadenectomy for a T2 gallbladder cancer. This tumor had originally been found at laparoscopic cholecystectomy approximately 1 year earlier. These unique sequelae of the interval development of nodal metastases to the axillary lymph nodes demonstrated in both cases has not been previously reported.     

腋腔镜淋巴结清扫术12例报告

目的:探讨腋腔镜淋巴结清扫术的临床应用及存在的问题。方法:回顾分析我院为12例乳腺癌患者施行腋窝脂肪抽吸后腋腔镜淋巴结清扫术的临床资料。结果:无一例中转开放手术。手术时间70～166min,平均82min。清除淋巴结16～29枚,平均20枚。4例有腋窝淋巴结转移,转移1～4枚。1例术后腋窝有积液,无其他术后并发症发生。结论:腋腔镜淋巴结清扫术具有传统开放手术所没有的微创优势和美容效果。     

A case of penetrating axillary trauma

Introduction

Deep penetrating traumas of the axilla extending to the neck are rare and potentially dangerous.

Observation

An 11-year-old child presented with an impressive penetrating axillary injury extending to the neck after falling on a tree branch. The wound was explored in the operating room (OR). A fragment of the branch was removed without injuring any vascular structure. The only lesion concerned the hypopharynx.

Discussion

Cervical wounds may have an axillary origin. These wounds must be systematically explored in the OR, given the risk of upper airway obstruction and vascular lesion.     

体外循环手术应用腋下及腋前外切口

自１９９５年３月至１９９６年８月作者应用腋下及腋前外切口进行体外循环手术５０例。房间隔缺损１７例，室间隔缺损２６例，二尖瓣狭窄及关闭不全３例，三房心、部分型心内膜垫缺损、双腔右心室、二尖瓣关闭不全各１例。全组手术顺利，主动脉阻断时间２２．５９±１１．０６分钟，体外循环时间４０．１９±１７．１７分钟。无手术死亡及并发症。创伤轻、出血少、恢复快、腋下切口看不见手术瘢痕、美容效果好。