caa a22 4500 445338857 CHVBK 20180317142805.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1245/s10434-011-1796-y doi (NATIONALLICENCE)springer-10.1245/s10434-011-1796-y Sentinel Lymph Node Pressure in Breast Cancer [Elektronische Daten] [S. Nathanson, Meredith Mahan] Background: Leakiness of angiogenic tumor vessels results in elevated pressure in primary breast cancers and increased lymphatic flow to sentinel lymph node(s) (SLNs). We hypothesized that a similar pathophysiology in metastatic axillary SLNs would result in increased intranodal pressure (INP). Methods: SLNs were "hot” and "blue” after intramammary injection of dilute methylene blue and filtered Tc99 sulfur colloid. Intraoperative pressure was measured in SLNs by a noncoring needle and recording device in 114 breast cancer patients. Excised axillary SLNs were examined by standard pathological techniques and metastases measured, recorded, and compared with INP measurements for SLN #1 and sometimes #2. Results: INP in 131 SLNs with no tumor (SLN #1, n=93; SLN #2, n=38) was 9.1±6.2 (SD; range −2, 35) mmHg and 21.4±15.4mmHg (range 0-50) in 35 tumor-containing SLNs (SLN #1, n=29; SLN #2, n=6) (P=0.0066). Elevated INPs significantly correlated with SLN tumor metastasis sizes (P=0.0038; r=0.4904). In two patients, tumor-laden SLNs with high INP were not blue or "hot” while a blue lymphatic bypassed these nodes and was traced to the next echelon tumor-free blue and "hot” nodes with low INP. Conclusions: Breast cancer metastasis in axillary SLNs was associated with significantly higher INP than in tumor-free lymph nodes. When "true” SLNs were replaced by tumor, and the INP levels were very high, lymph flow direction changed; lymphophilic particles (blue dye and radiocolloid) were redirected to the next echelon of nodes, where the pressures were much lower. Mechanical factors may increase the likelihood of metastasis to neighboring lymph nodes with lower INP. Society of Surgical Oncology, 2011 Nathanson S. Department of Surgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA aut Mahan Meredith Division of Biostatistics, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA aut Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3791-3796 1068-9265 18:13<3791 2011 18 10434 https://doi.org/10.1245/s10434-011-1796-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1796-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Nathanson S. Department of Surgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA aut NATIONALLICENCE 700 1- Mahan Meredith Division of Biostatistics, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3791-3796 1068-9265 18:13<3791 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer