Importância da Linfadenectomia Axilar no Tratamento Cirúrgico do Câncer da Mama

Abstract

There is no doubt about the importance of axillary lymph nodes in the treatment and prognosis of breast cancer in order to observe this undera surgical point of view, 151 mastectomy specimens were studied (104 with Halsted-Meyer and 47 with Patey-Dyson techniques). A total of 5,015 axillary nodes were dissected and the median number per axilla was 33.2 nodes. No special method for searching nodes in surgical specimens was used. There was no significant difference between the median number of lymph nodes present in axilla with one or another surgical technique. The lymph nodes were divided according to the drainage levels and their larger diameter There was a correlation between node diameter and its histological compromising and we concluded that node diameter can be another prognostic indicator to breast cancer The small lymph nodes (less than 0.5 cm) were found in all drainage levels, inversely in relation to the nodes with more than 2cm: they were almost exclusively found at level I. Othervvise, these latest lymph nodes present na histologic positive rate higher than the other ones. The false negatives were 22.5% and were higher among cases with initial stages. The conviction about the histologic positiveness of axillary lymph can only be obtained if all dissected nodes are examined. That will be possible after a good axillary dissection, including remotion of pectoralis minor muscle. Therefore, conservative techniques with preservation of both pectoralis muscles, carry an incomplete axillary dissection. Histologic positivity of lymph nodes present at superior leveis without the compromising of the first level was rare as well as, it was also rare histologic positivity of small lymph nodes without involvement of the larger lymph nodes. A specific lymph node group was described, one of the highest level, called PARA-CEPHALIC GROUP, found in 34 specimens (22.5%). Clinically negatives nodes with less than 0.5cm in diameter but histologically positive can be called MINIMAL AXILLARY BREAST METASTASES.