title: Great tumour burden in the axilla may influence lymphatic drainage in breast cancer patients.
abstract: We investigated whether great tumour burden in the primary draining lymph node would lead to obstructed lymphatic flow in breast cancer patients. Breast cancer patients with false-negative sentinel lymph nodes (SLNs) were enrolled from January 2001 to March 2011, retrospectively. A further 45 breast cancer patients were recruited prospectively from December 2013 to November 2014. Carbon nanoparticles, a lymphatic tracer, were injected into the subareolar area 24 h before surgery, followed by axillary lymph node dissection. In the SLN cohort, among the 28 false-negative cases, >50 % showed great tumour burden in the axilla. In the carbon nanoparticles cohort, we found that cases with <3 nodes involved in the pathology had more lymph nodes stained by carbon nanoparticles than the subgroup with ≥3 involved nodes (P = 0.003). Nodes stained with carbon nanoparticles showed smaller tumour burdens compared with unstained nodes (P < 0.05). Furthermore, five cases showed metastatic nodes that were not stained with carbon nanoparticles, and all the lymph nodes that were free of metastasis were stained with carbon nanoparticles. Great tumour burden in the axilla might lead to lymphatic flow obstructions in clinical practice. Nevertheless, clinical trials are still needed to validate our findings.
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.|Department of General Surgery, Puyang Oilfield General Hospital, 124 Daqing Road, Puyang, 457001, China.
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Pan
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Xiuqing
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zha
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.affiliation: Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China. wangcongcc@vip.sina.com.
authors.forename: Cong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China. liuxiaoan@126.com.
authors.forename: Xiaoan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China. ws0801@hotmail.com.
authors.forename: Shui
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D002244:Carbon / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D053758:Nanoparticles; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D047368:Tumor Burden
chemical_list: D002244:Carbon
keywords: Axilla; Breast cancer; Lymphatic drainage; Tumour burden