Evaluation of the recipient zone of fat tissue transplantation in the area of lymphadenectomy after radical mastectomy in patients with breast cancer

Abstract

Objective: to study the morphofunctional state of the recipient zone of adipose tissue transplantation in the lymphadenectomy area after radical breast cancer surgery. Material and Methods. A single-center retrospective-prospective comparative study included 147 patients with histologically confirmed breast cancer, who were treated at Tomsk Regional Oncology Center in 2022–2023. All patients underwent radical mastectomy with axillary lymph node dissection (levels I–III). The study group consisted of 78 patients who underwent axillary lipofilling, and the control group included 69 patients who underwent vacuum drainage. Inclusion criteria: histologically confirmed breast cancer, radical mastectomy with level I–III axillary lymph node dissection, absence of previous surgery or radiotherapy to the axillary region and written informed consent. Exclusion criteria were distant metastases and severe sub-/decompensated comorbidities. The recipient zone was assessed 12–24 months later using imaging techniques and anthropometry of the upper extremities. Ultrasound examination with compression elastometry and shear wave elastography was performed in 21 patients from the study group and in 14 patients from the control group. Lymphoscintigraphy with SPECT/CT was performed in 24 patients from the study group and in 21 from the control group. Results. Comprehensive analysis showed that in 90.5 % of patients in the study group the transplanted adipose tissue was preserved in the recipient zone and had a density corresponding to the reference range of 2–5 kPa. In 19 patients, the median density of the integrated adipose tissue was 3.8 (3.1; 5.9) kPa. The volume of integrated adipose tissue in the recipient zone was 10.50 (7.33; 17.75) cm 3 and 11.75 (8.82; 18.50) cm 3 after excluding isolated cases of scar replacement. According to compression elastography, the transplanted adipose tissue corresponded to elastotype 2, whereas in the control group the recipient zone demonstrated features of scar tissue. On lymphoscintigraphy of the operated side, the transport index was 13.8 (10.8; 18.8) in the study group and 26.8 (19.3; 32.8) in the control group; background radiopharmaceutical accumulation in the forearm soft tissues was 18 (10; 34) and 42 (28; 66) respectively. Differences between the groups in transport index and background radiopharmaceutical accumulation were statistically significant (p=0.03 and p=0.012). Conclusion. transplantation of autologous adipose tissue into the axillary lymphadenectomy area ensures its integration in the recipient zone and is associated with more favorable morphofunctional tissue characteristics and lymphatic transport parameters compared with standard drainage.