MICROSURGICAL METHODS OF EX VIVO EXAMINATION OF THE LYMPHATIC SYSTEM IN BREAST CANCER PATIENTS

The purpose of the study was ex vivo examination of lymph node perfusion in patients with metastatic breast cancer.

Material and Methods. Lymph nodes affected with metastatic breast cancer were examined. These nodes were subsequently subjected to microsurgical dissection with the isolation of the capsule, lymphatic vessels, parenchyma and stroma. All manipulations were performed after preliminary lymph node dissection using an axillary node sample, and the dissection of an isolated lymph node from this region was then performed. A total of 100 breast cancer patients underwent lymph node dissection and microsurgical lymph node dissection. The control group comprised samples taken from women who died in accidents and had no a history of cancer. Lymph nodes and vessels were isolated from the adipose tissue of the axillary region by the sonolipodestruction technique using LySonix 3000® ultrasonic device with PulseSelect™. A detailed examination of lymph nodes was carried out using OPTON microscope – OPMI 6 CFC and a set of microsurgical instruments. Color lymphography of isolated afferent lymphatic vessels with 0.5 % methylene blue solution was performed. Along with color lymphography, digital morphometry of the components of the lymphatic system (Image-Pro Plus 6.0) and microsurgical dissection of the lymph node capsule and lymphangion valves were performed.

Results. Data on non-metastatic and metastatic lymph nodes were obtained and digitally recorded. When studying the metastatic blockade of the lymphoid lobule and afferent lymphatic vessels by the method of antegrade color lymphography, we revealed the compensatory development of lymphatic bypass – intracapsular neo-lymphatic microangiogenesis that was confirmed by histological studies.

Conclusion. Color lymphography reliably determines the areas and the extent of functional perfusion. Post-radiation changes in tissues markedly change the logistics of lymph flow and regional metastasis. The lymph node capsule with metastases undergoes a pathological transformation characterized by the development of a network of lymphatic capillaries, the severity of which depends on the extent of metastatic block. Lymph node metastasis changes the lymphatic hydrodynamics by changing the number of lymphatic vessels and their diameter.

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