Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

Background: Breast cancer is one of the most leading causes of cancer deaths in female. Surgical treatment is considered the corner stone in its management. Axillary lymph node dissection (ALND) is an integral step in most of surgeries done, however it has many morbidities like prolonged seroma and lymphedema. Axillary reverse mapping (ARM) procedure was first described in 2007 in a trial to map the axillary lymphatics of the arm and avoid its injury therefore lymph complications.Methods: A prospective, randomized, controlled study over 72 female patients who underwent modified radical mastectomy (MRM). Patients were divided and randomized into study and control groups, thirty-six patients for each. In study group the ARM procedure was done by injecting 2.5 ml of methylen blue dye intra-dermally and subcutaneously in the upper inner ipsilateral arm along the medial intramuscular groove before ALND. Operative and post-operative results were recorded. Follow up was 6 to 24 months.Results: ARM procedure and successful visualization of arm lymphatics was achieved in 31 patients (86.1%). Statistically there was no significant difference between the two groups regarding patient and tumour characteristics, operative time and number of excised L.Ns. There was significant difference favouring the ARM group in decreasing the incidence of seroma (p= 0.040), lymphedema (p= 0.031) and time passed till remove drains (p <0.001).Conclusions: ARM procedure facilitated arm lymphatics visualization. It is easy non-time-consuming procedure. It resulted in significant reduction in incidence of seroma and lymphedema, with considerable reduction in the overall complications rate.

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Oncological Safety of Axillary Reverse Mapping in Patients With Clinically Node-Negative Breast Cancer

10.21203/rs.3.rs-501178/v1 ◽

2021 ◽

Author(s):

Masakuni Noguchi ◽

Masafumi Inokuchi ◽

Miki Yokoi-Noguchi ◽

Emi Morioka

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymphatic Drainage ◽

Blue Dye ◽

Axillary Lymph ◽

Oncological Safety ◽

Axillary Reverse Mapping ◽

Node Negative Breast Cancer ◽

Positive Slns ◽

Reverse Mapping

Abstract Background Axillary reverse mapping (ARM) was developed to preserve the lymphatic drainage from the upper arm during sentinel lymph node (SLN) biopsy or axillary lymph node dissection (ALND). However, the oncological safety of ARM has been controversial. Methods Patients with clinically negative nodes (cN0) underwent SLN biopsy and ARM. SLNs were identified using blue dye and radioisotope, and ARM nodes were traced using the fluorescent method. Patients with positive SLN underwent the standard ALND. After surgery, they were followed up for more than three years. Results A total of 507 patients with cN0 breast cancer were enrolled between May 2009 and November 2017. SLNs were identified in 499 (98%) of 507 patients, and ARM nodes were identified in 159 (31%) patients in the SLN field. The crossover rate of SLN-ARM nodes was 28%. Among 95 patients with positive SLNs, 70 patients underwent conventional ALND. ARM nodes were identified in 65 (93%) of those patients in the ALND field. The mean number of removed ARM nodes was 7.2 (range 0–25) in patients who underwent the standard ALND. Although ARM nodes were involved in 18 of 65 patients, the involved ARM nodes were the same SLNs identified in 14 (78%) patients. Since SLN-ARM nodes should be removed, ARM nodes were involved only in 4 (5.7 %) patients after SLN biopsy. Conclusions ARM nodes were not infrequently involved in patients with positive SLNs, but they were most often SLNs. Therefore, conservative ALND with ARM is oncologically acceptable in patients with positive SLN.

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Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

Journal of Oncology ◽

10.1155/2019/8637895 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Xiaokai Ma ◽

Shishuai Wen ◽

Baofeng Liu ◽

Dumin Li ◽

Xiaolong Wang ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Upper Extremity ◽

Axillary Lymph Node ◽

Lymphatic Drainage ◽

Sentinel Lymph Nodes ◽

Blue Dye ◽

Axillary Lymph ◽

Axillary Reverse Mapping

Purpose. The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients.Methods. Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping.Results. ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs.Conclusions. The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema.Clinical Trial Registration. This trial is registered with ClinicalTrial.gov:NCT02651142.

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Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique

Journal of Clinical Medicine ◽

10.3390/jcm10235707 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5707

Author(s):

Alexandra Caziuc ◽

Diana Schlanger ◽

Giorgiana Amarinei ◽

Vlad Fagarasan ◽

David Andras ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Axillary Lymph Node ◽

Histological Evaluation ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Reverse Mapping ◽

Metastatic Involvement ◽

Reverse Mapping

Introduction. Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. Material and methods. In total, 30 breast cancer patients scheduled for axillary lymph node dissection were enrolled in our study. The lymphatic nodes that drain the arm were identified by injecting 1 mL of blue dye in the ipsilateral upper arm; then, the ARM nodes were resected along with the other lymph nodes and sent for histological evaluation. Results. Identification of ARM node was successful in 18 patients (60%) and 22.22% of the identified ARM lymph nodes had metastatic involvement. Patients with identified ARM nodes had a significant lower BMI and a statistically significant relationship between axillary lymph node status and ARM node metastases was proven. Most of ARM lymph nodes (96.3%) were found above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle. Conclusions. The ARM procedure is easy to reproduce but might not be appropriate for patients with a high BMI. The rate of metastatic involvement of ARM nodes is significant and no factor can predict it, showing that the preservation of these nodes cannot be considered.

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Extensive Nodal Disease May Impair Axillary Reverse Mapping in Patients With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.22.1846 ◽

2009 ◽

Vol 27 (33) ◽

pp. 5547-5551 ◽

Cited By ~ 36

Author(s):

Riccardo Ponzone ◽

Nicoletta Tomasi Cont ◽

Furio Maggiorotto ◽

Elisa Cassina ◽

Paola Mininanni ◽

...

Keyword(s):

Breast Cancer ◽

Axillary Staging ◽

Blue Dye ◽

Nodal Disease ◽

Detection Rates ◽

Axillary Reverse Mapping ◽

Patent Blue ◽

Blue Node ◽

Metastatic Cells ◽

Reverse Mapping

Purpose The aim of axillary reverse mapping (ARM) is to preserve arm lymphatics in patients with breast cancer who underwent surgical axillary staging. Patients and Methods From June 2007 to December 2008, 49 patients who required axillary dissection (AD) underwent ARM. One milliliter of patent blue dye was injected in the ipsilateral arm, and all blue nodes identified during AD were sent separately for pathologic examination. Main variables associated with the detection rates of blue lymphatics, the pathologic status of blue and nonblue nodes, and the complications of the procedure were analyzed. Results Identification rates of blue lymphatics and blue nodes were 73.5% and 55.1%, respectively. Blue node identification was influenced by the time elapsed between injection of blue dye and surgery (P = .002) but not by the learning curve of the procedure. Although the blue node was clear of metastases in 24 of 27 patients, three patients with extensive nodal metastatic involvement (ie, pN2a and pN3a) showed breast cancer metastatic cells in the blue nodes as well. The only adverse effect of the procedure was skin tattooing at the injection site, which disappeared within 4 months in almost 80% of the procedures. Conclusion In patients with clinically negative axillary nodes, additional study is warranted to assess whether ARM may be used to spare the lymphatics from the arm. In the presence of extensive nodal disease, this technique may identify metastatic blue nodes, which demonstrates that there is not reliable separation of arm and breast lymphatic pathways.

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Prevention of lymphedema via axillary reverse mapping for arm lymph-node preservation following breast cancer surgery: a randomized controlled trial

Patient Safety in Surgery ◽

10.1186/s13037-019-0217-1 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Mohammed Faisal ◽

Mohamed Gamal Sayed ◽

Kerolos Antonious ◽

Ahmmed Abo Bakr ◽

Sherif Hussein Farag

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Control Group ◽

Study Group ◽

Axillary Lymph ◽

Axillary Reverse Mapping ◽

Axillary Surgery ◽

Arm Lymphedema ◽

Reverse Mapping

Abstract Background Breast cancer, with an incidence of 32%, is the most frequent cancer among Egyptian women. The frequency of arm lymphedema after axillary surgery for breast cancer ranges from 7 to 77%. Axillary reverse mapping is a technique aimed to distinguish and conserve upper-limb lymphatics and lymph nodes during the course of axillary surgery and could help to prevent arm lymphedema. Methods Patients (n = 48) were prepared for axillary lymph-node dissection. The study group and the control group each contained 24 individuals. In the study group, following dye injection, stained arm lymph nodes and lymphatics were conserved during axillary dissection, whereas control-group participants underwent the conventional procedure. All participants were re-evaluated after 6 months, and the incidence of lymphedema was recorded by measuring arm circumference at a level 10 cm proximal to the medial epicondyle. Arm lymphedema was defined as a change in the circumference of the ipsilateral upper extremity > 2 cm during the follow-up period. Results Age, tumor size and N stage were not significantly different between the study and control groups. Lymph-node visualization was achieved in 20 participants (83.3%) in the study group. Suspicious stained lymph nodes were surgically removed from four individuals but showed no metastatic involvement. In 20 individuals in the study group, no stained lymph nodes were removed. The incidence of lymphedema in the control group was 16.7%, and the incidence in the study group was 4.2%. Conclusions Axillary reverse mapping is a minimally invasive technique that can be performed during axillary lymph-node dissection, helping to prevent the subsequent development of arm lymphedema. Trial registration #SCURCTN3276, retrospectively registered on 11 April 2017 at Research Ethics Committee at the Faculty of medicine-Suez Canal University.

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A study on the feasibility of axillary reverse mapping with blue dye only in breast cancer patients

International Surgery Journal ◽

10.18203/2349-2902.isj20194056 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3229

Author(s):

Subbiah Shanmugam ◽

Syed Afroze Husssain ◽

Muralikannan .

Keyword(s):

Breast Cancer ◽

Methylene Blue ◽

Cancer Patients ◽

Blue Dye ◽

Complication Rates ◽

Breast Cancer Patients ◽

Axillary Reverse Mapping ◽

Blue Node ◽

Level 1 ◽

Reverse Mapping

Background: Axillary reverse mapping is (ARM) the concept of visualization of the nodes in axilla that drain the arm and preserving them. Literature describes this procedure being done with blue dye (methylene blue) and 99mTC technetium sulphur colloid. This study was undertaken to look for the feasibility of axillary reverse mapping using blue dye alone as there is lack of availability of the radio colloid in many centres in India.Methods: 30 breast cancer patients who underwent axillary dissection as part of their surgery were included in the study. 2.5–5 ml of methylene blue was injected in the medial upper arm in the intermuscular groove region. The number of blue nodes identified, their location, pathological status and procedure related complications were analysed.Results: The ARM blue node was identified only in 7 out of the 30 patients (sensitivity– 23%) and none had a pathologically positive blue node. In those 7 patients, only 1 blue node was identified. All the nodes were in level 1 and the largest node measured 2cm in largest dimension. The complications associated with the procedure included pain, pigmentation, induration and skin necrosis. 16 (53.3%) had pain, 10 (33.3%) had induration, 6 (20%) had pigmentation and 1 (3.33%) had skin necrosis.Conclusions: The feasibility of ARM being done using blue dye alone needs to be questioned in view of its poor sensitivity. Added to this, the complication rates are higher. However, larger studies are needed to validate the same or otherwise.

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Axillary Reverse Mapping in Preventing Lymphedema in Patients With Breast Cancer Undergoing Axillary Lymph Node Dissection

Case Medical Research ◽

10.31525/ct1-nct03927027 ◽

2019 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Axillary Lymph Node Dissection ◽

Lymph Node Dissection ◽

Axillary Lymph Node ◽

Axillary Lymph ◽

Node Dissection ◽

Axillary Reverse Mapping ◽

Reverse Mapping

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The Comparison of Total Drain Volume In Post MRM Patient Using Songket Design And Tewart Design At Dr. Mohammad Hoesin Hospital Palembang

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v3i2.43 ◽

2020 ◽

Vol 3 (2) ◽

pp. 163-173

Author(s):

Meigi Medika ◽

Nur Qodir

Keyword(s):

Breast Cancer ◽

Radical Mastectomy ◽

Wound Dehiscence ◽

Suture Technique ◽

P Value ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Mattress Suture ◽

Significant Difference ◽

History Of

ABSTRACTBackground: In 2018, breast cancer was the most common malignancies in women. Which mainmodality for the management is surgery. The most frequently-used incision design is Stewartincision. Its disadvantages were difficult to access axillary, surgical scar, lateral ear dog and theloss of anterior axillary fold. Another design used is Songket design which consists of crescentincision, rule of half buried mixed mattress suture technique and axillary anker suture. This studyaims were to compare the total drain volume of post-MRM breast cancer patients between Songketand Stewart incision design.Method: Clinical randomized control trial (cRCT) research is the most robust design forevaluating the interventions used. Samples were all post-Modified Radical Mastectomy CaMammae patients with Songket and Stewart incision design who were hospitalized in theDepartment of Surgery at Dr. Mohammad Hoesin Hospital Palembang in the time of June -November 2019. The inclusion criteria were Ca Mammae patients who underwent the procedureand agreed to participate for this study. The patients who had post-operative wound dehiscence,under-documented drains, or the history of axillary lymph node surgery were excluded from this study.Results: Total drain volume for post-MRM using Stewart incision was 613.85 ± 215.93 ml, whileSongket Incision stood was 116.15 ± 139.95 ml. The mean age of the study subjects was 48.69 ±9.57. BMI was 23.65 ± 3.51 on average. Total drain volume of Stewart incision design was 497.7± 75.98 higher than Songket incision design.Conclusion: There was found significant difference in total drain volume between the two groupswith p value of <0.001.

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Local Recurrence of Breast Cancer after MammoSite® Brachytherapy

The American Surgeon ◽

10.1177/000313480607200907 ◽

2006 ◽

Vol 72 (9) ◽

pp. 798-801

Author(s):

Matthew Voth ◽

Raye Budway ◽

Angela Keleher ◽

Philip F. Caushaj

Keyword(s):

Breast Cancer ◽

Treatment Plan ◽

Breast Conservation ◽

Radical Mastectomy ◽

Axillary Lymph ◽

Ultrasound Guided ◽

Breast Pathology ◽

Poorly Differentiated ◽

Her 2 ◽

Negative Tumor

Women undergoing breast conservation therapy (BCT) for stage 1 breast cancer have adjuvant external beam radiotherapy (EBR). In addition, the use of brachytherapy radiation is being used. We present two local tumor recurrences for review. Our first patient underwent BCT, sentinel lymph node biopsy (SLNBx) and MammoSite® brachytherapy for a T1N0M0 infiltrating ductal carcinoma (IDC) of the right breast. Pathology: 0.6 cm poorly differentiated ER, PR, and Her-2/ Neu negative IDC. At 18 months, she had palpable axillary lymph nodes. Fine needle aspiration and ultrasound-guided core biopsy of a nodule showed IDC. She underwent modified radical mastectomy (MRM) and EBR. Our second patient underwent BCT, SLNBx, and MammoSite® brachytherapy for a T1N0M0 IDC of the left breast. Pathology: 0.8 cm poorly differentiated, ER+, PR-, and Her-2/Neu negative tumor. At 18 months, a retroareolar mass was detected. Ultrasound guided core needle biopsy showed recurrent IDC. She chose a re-excision and EBR and not MRM. Pathology: 1.3 cm poorly differentiated, ER+, PR-, and Her-2/Neu negative tumor. Our 2 recurrences were >2 cm away from the lumpectomy site and therefor outside the 1 cm treatment plan of the MammoSite® catheter. Both recurrences were biologically identical to the initial tumors and are felt to be local failures rather than new primaries.

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