Anatomical rationale for tissue defect volumein sentinel lymph node biopsy: a pilot study on autopsy samples

Background. Despite being less invasive compared to axillary lymph node dissection, sentinel lymph node biopsy in breast cancer remains a procedure associated with the risk of developing lymphorrhea and lymphedema. One theoretically justified approach to preventing these complications is autologous fat tissue transplantation to fill the postoperative tissue defect; however, the evidence base for this method is absent, and the optimal transplant volume has not been determined.

Objective. To obtain preliminary anatomical data on the volume of tissue defect formed during sentinel lymph node biopsy, depending on anthropometric parameters, to justify the design of a prospective clinical study.

Materials and Methods. A pilot anatomical study was performed on 12 female cadaveric specimens aged 65.1±16.9 years with different body mass indices. Sentinel lymph node biopsy simulation included a standardized incision, removal of level I lymph node with surrounding fat tissue, and measurement of residual defect volume using the plaster solution filling method followed by volumetry. Correlation analysis of defect volume dependence on body mass index and age was performed.

Results. The mean tissue defect volume was 3.5±0.6 cm³. A positive correlation was found with body mass index (r=0.70; p=0.012) and age (r=0.61; p=0.035). The largest volume was recorded at body mass index over 25 kg/m² and in the age group 72-82 years; the smallest – at body mass index less than 18.5 kg/m² and in the group 48–59 years.

Conclusions. Preliminary anatomical data on the variability of tissue defect volume during sentinel lymph node biopsy simulation were obtained. The results justify the need for a prospective clinical study to validate the in vivo measurement method and assess the clinical significance of personalized autograft volume selection. Cadaveric material has critical limitations and does not allow extrapolation of data to clinical practice.

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