Minimize the extent and morbidity of axillary dissection for node-positive breast cancer patients: implementation of axillary lymph node dissection based on breast lymphatics level

Abstract Background Breast cancer-related lymphedema (BCRL) is associated with extensive axillary dissection. Axillary lymph node dissection (ALND) based on breast lymphatics level (BLL) was proposed to minimize the surgical extent for node-positive cancer patients. Methods A total of 156 consecutive sentinel (SLN+) or clinically (cN+) patients underwent biopsy (SLNB) indocyanine green and methylene blue (MB). The SLNs were injected 0.1 ml MB before removal, a standard ALND subsequently performed. nodes adjacent blue-stained from (bALNs) sent pathological examination separately by resecting serial tissue every 0.5 cm away marginal bALNs. Then, pilot study comparing BLL Results successfully identified in 20 SLN+ (100%) 134 cN+ (98.5%) median number four, ranging three six. horizontal line 1.0 superior bALN vertical medial formed II, III, IV. All additional positive within minimized should resect upwards lowest that contains first confirmed negative In study, no patient developed recurrence. Conclusion procedure could potentially reduce BCRL rate. Trial registration ChiCTR1800014247 .