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Great tumour burden in the axilla may influence lymphatic drainage in breast cancer patients

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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.

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References

  1. Giuliano AE, Jones RC, Brennan M, Statman R (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15(6):2345–2350

    CAS  PubMed  Google Scholar 

  2. Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, Benson AB 3rd, Bosserman LD, Burstein HJ, Cody H 3rd, Hayman J, Perkins CL, Podoloff DA, Giuliano AE (2014) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 32(13):1365–1383. doi:10.1200/jco.2013.54.1177

    Article  PubMed  Google Scholar 

  3. Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 106(1):4–16. doi:10.1002/cncr.21568

    Article  PubMed  Google Scholar 

  4. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, Weaver DL, Miller BJ, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Mammolito DM, McCready DR, Mamounas EP, Costantino JP, Wolmark N (2007) Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 8(10):881–888. doi:10.1016/s1470-2045(07)70278-4

    Article  CAS  PubMed  Google Scholar 

  5. Goyal A, Newcombe RG, Chhabra A, Mansel RE (2006) Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat 99(2):203–208. doi:10.1007/s10549-006-9192-1

    Article  PubMed  Google Scholar 

  6. Wang M, Zhou W, Zhao Y, Xia T, Zha X, Ding Q, Liu X, Zhao Y, Ling L, Chen L, Wang S (2012) A novel finding of sentinel lymphatic channels in early stage breast cancer patients: which may influence detection rate and false-negative rate of sentinel lymph node biopsy. PLoS One 7(12):e51226. doi:10.1371/journal.pone.0051226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wei S, Bleiweiss IJ, Nagi C, Jaffer S (2014) Characteristics of breast carcinoma cases with false-negative sentinel lymph nodes. Clin Breast Cancer 14(4):280–284. doi:10.1016/j.clbc.2013.12.009

    Article  PubMed  Google Scholar 

  8. Kohl Schwartz AS, Leo C, Rufibach K, Varga Z, Fink D, Gabriel N (2013) Does increased tumor burden of sentinel nodes in breast cancer affect detection procedure? Eur J Surg Oncol 39(3):266–272. doi:10.1016/j.ejso.2012.12.016

    Article  CAS  PubMed  Google Scholar 

  9. Goyal A, Douglas-Jones AG, Newcombe RG, Mansel RE (2005) Effect of lymphatic tumor burden on sentinel lymph node biopsy in breast cancer. Breast J 11(3):188–194. doi:10.1111/j.1075-122X.2005.21591.x

    Article  PubMed  Google Scholar 

  10. Tafra L, Lannin DR, Swanson MS, Van Eyk JJ, Verbanac KM, Chua AN, Ng PC, Edwards MS, Halliday BE, Henry CA, Sommers LM, Carman CM, Molin MR, Yurko JE, Perry RR, Williams R (2001) Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 233(1):51–59

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Proulx ST, Luciani P, Christiansen A, Karaman S, Blum KS, Rinderknecht M, Leroux JC, Detmar M (2013) Use of a PEG-conjugated bright near-infrared dye for functional imaging of rerouting of tumor lymphatic drainage after sentinel lymph node metastasis. Biomaterials 34(21):5128–5137. doi:10.1016/j.biomaterials.2013.03.034

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Leijte JA, van der Ploeg IM, Valdes Olmos RA, Nieweg OE, Horenblas S (2009) Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med 50(3):364–367. doi:10.2967/jnumed.108.059733

    Article  PubMed  Google Scholar 

  13. Suga K, Yuan Y, Okada M, Matsunaga N, Tangoku A, Yamamoto S, Oka M (2004) Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience. Radiology 230(2):543–552. doi:10.1148/radiol.2302021380

    Article  PubMed  Google Scholar 

  14. Yang Q, Wang XD, Chen J, Tian CX, Li HJ, Chen YJ, Lv Q (2012) A clinical study on regional lymphatic chemotherapy using an activated carbon nanoparticle-epirubicin in patients with breast cancer. Tumour Biol 33(6):2341–2348. doi:10.1007/s13277-012-0496-y

    Article  CAS  PubMed  Google Scholar 

  15. Hao RT, Chen J, Zhao LH, Liu C, Wang OC, Huang GL, Zhang XH, Zhao J (2012) Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma. Eur J Surg Oncol 38(8):718–724. doi:10.1016/j.ejso.2012.02.001

    Article  CAS  PubMed  Google Scholar 

  16. Zhu Y, Chen X, Zhang H, Chen L, Zhou S, Wu K, Wang Z, Kong L, Zhuang H (2015) Carbon nanoparticle-guided central lymph node dissection in clinically node-negative patients with papillary thyroid carcinoma. Head Neck. doi:10.1002/hed.24060

    Google Scholar 

  17. Wang B, Qiu NC, Zhang W, Shan CX, Jiang ZG, Liu S, Qiu M (2015) The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma. Surg Endosc 29(10):2914–2920. doi:10.1007/s00464-014-4020-x

    Article  PubMed  Google Scholar 

  18. Cai HK, He HF, Tian W, Zhou MQ, Hu Y, Deng YC (2012) Colorectal cancer lymph node staining by activated carbon nanoparticles suspension in vivo or methylene blue in vitro. World J Gastroenterol 18(42):6148–6154. doi:10.3748/wjg.v18.i42.6148

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Zhou W, He Z, Xue J, Wang M, Zha X, Ling L, Chen L, Wang S, Liu X (2012) Molecular subtype classification is a determinant of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes. PLoS One 7(4):e35881. doi:10.1371/journal.pone.0035881

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhao YC, Ni XJ, Wang MH, Zha XM, Zhao Y, Wang S (2012) Tumor-derived VEGF-C, but not VEGF-D, promotes sentinel lymph node lymphangiogenesis prior to metastasis in breast cancer patients. Med Oncol 29(4):2594–2600. doi:10.1007/s12032-012-0205-0 (Northwood, London, England)

    Article  CAS  PubMed  Google Scholar 

  21. Pritchard KI, Julian JA, Holloway CM, McCready D, Gulenchyn KY, George R, Hodgson N, Lovrics P, Perera F, Elavathil L, O’Malley FP, Down N, Bodurtha A, Shelley W, Levine MN (2012) Prospective study of 2-[(1)(8)F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study. J Clin Oncol 30(12):1274–1279. doi:10.1200/jco.2011.38.1103

    Article  CAS  PubMed  Google Scholar 

  22. Boughey JC, Ballman KV, Hunt KK, McCall LM, Mittendorf EA, Ahrendt GM, Wilke LG, Le-Petross HT (2015) Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). J Clin Oncol 33(30):3386–3393. doi:10.1200/jco.2014.57.8401

    Article  CAS  PubMed  Google Scholar 

  23. Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B (2008) Axillary lymph nodes: US-guided fine-needle aspiration for initial staging of breast cancer—correlation with primary tumor size. Radiology 246(1):81–89. doi:10.1148/radiol.2463061463

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported in part by the National Natural Science Foundation of China (81502299, 81502286, 81572595, 81572602 and 81572607), the Natural Science Foundation of Jiangsu Province (BK20141023), the Program for Development of Innovative Research Team in the First Affiliated Hospital of NJMU (IRT-008) and a project Funded by the Priority Academic Program Development of Jiangsu higher Education Institutions (PAPD).

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    Authors and Affiliations

    1. Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

      Wenbin Zhou, Yansheng Zhao, Hong Pan, Qin Li, Xiuqing Li, Lin Chen, Xiaoming Zha, Qiang Ding, Xiaoan Liu & Shui Wang

    2. Department of General Surgery, Puyang Oilfield General Hospital, 124 Daqing Road, Puyang, 457001, China

      Yansheng Zhao

    3. Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

      Cong Wang

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    1. Wenbin Zhou
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    2. Yansheng Zhao
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    3. Hong Pan
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    Correspondence to Cong Wang, Xiaoan Liu or Shui Wang.

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    The authors declare that all procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    Wenbin Zhou, Yansheng Zhao and Hong Pan contributed equally to this work.

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    Zhou, W., Zhao, Y., Pan, H. et al. Great tumour burden in the axilla may influence lymphatic drainage in breast cancer patients. Breast Cancer Res Treat 157, 503–510 (2016). https://doi.org/10.1007/s10549-016-3831-y

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    • DOI: https://doi.org/10.1007/s10549-016-3831-y

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