To explore the clinical application of reverse axillary lymphography (RAL) for patients with breast cancer and to analyze the distribution and metastasis characteristics of upper extremity lymph nodes.

130 women with breast cancer who underwent primary surgical treatment between June 2017 and February 2020 were prospectively enrolled into the present study. All of them underwent reverse axillary lymphography. Statistical analysis were performed byusing SPSS23.0 software. The upper extremity diameter were expressed as (±s) and were analyzed by using t test. The single-factor analysis of upper extremity reflux lymph node metastasis was analyzed by using 2 test. Multivariate analysis of upper extremity reflux lymph node metastasis was performed by using Logistic regression analysis. A P value of <0.05 was considered as statistically significant difference.

Among the 122 patients, 501 upper extremity reflux lymph nodes were successfully tracked, with A tracking success rate of 93.8%. In A and B regions, there were 327 and 106 tracked lymph nodes respectively, accounting for 83.1%, which was significantly higher than that in other regions (P<0.05). The direction of the upper extremity lymph nodes was along with the axillary vein, the second intercostal brachial nerve, the thoracic dorsal neurovascular bundle, the latissimus dorsi leading edge and the serratus anterior muscle, which were mainly around the axillary vein; Single factor analysis showed that the axillary lymph node status, BMI, tumor distribution location and upper extremity diameter of the patients were related to reflux lymph node metastasis (P<0.05), Logistic regression analysis further showed that the condition of axillary lymph nodes and tumor distribution were independent risk factors for RAL of upper limb reflux lymph node metastasis.

RAL provides a more precise location of upper limb reflux lymph node metastasis, through accurate analysis of the individual's physical condition and understanding of the lymphatic distribution and trend, the integrity of the lymphatic system could be improved, which has certain significance in reducing the rate of postoperative lymphedema and improving the success rate of surgery.