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

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

International Surgery Journal ◽

10.18203/2349-2902.isj20173204 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2397 ◽

Cited By ~ 1

Author(s):

Ahmed Gaber ◽

Ahmed Fawzy ◽

Ahmed Sabry ◽

Alaa El sisi

Keyword(s):

Breast Cancer ◽

Radical Mastectomy ◽

Controlled Study ◽

Blue Dye ◽

Axillary Lymph ◽

Axillary Reverse Mapping ◽

Significant Difference ◽

Complications Rate ◽

And Control ◽

Reverse Mapping

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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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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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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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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Assessment of the efficacy and oncological safety of sentinel lymph node biopsy in node-negative breast cancer using methylene blue dye

The Egyptian Journal of Surgery ◽

10.4103/ejs.ejs_87_17 ◽

2018 ◽

Vol 37 (1) ◽

pp. 31

Author(s):

SheriefM Mohsen ◽

Rania Elahmady

Keyword(s):

Breast Cancer ◽

Methylene Blue ◽

Lymph Node ◽

Lymph Node Biopsy ◽

Blue Dye ◽

Methylene Blue Dye ◽

Node Negative ◽

Oncological Safety ◽

Node Biopsy ◽

Node Negative Breast Cancer

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The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽

10.3390/healthcare9040471 ◽

2021 ◽

Vol 9 (4) ◽

pp. 471

Author(s):

Min Young Lee ◽

Eunjung Kong ◽

Dong Gyu Lee

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymphatic Drainage ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

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Evaluating One Day versus Two Days Preoperative Lymphoscintigraphy Protocols for Sentinel Lymph Node Biopsy in Breast Cancer

The American Surgeon ◽

10.1177/000313481508100524 ◽

2015 ◽

Vol 81 (5) ◽

pp. 454-457 ◽

Cited By ~ 3

Author(s):

Michael G. Mount ◽

Nicholas R. White ◽

Christophe L. Nguyen ◽

Richard K. Orr ◽

Robert B. Hird

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Axillary Lymph Node ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Axillary Lymph Node Metastases ◽

Node Biopsy ◽

Node Negative Breast Cancer

Sentinel lymph node biopsy (SLNB) is used to detect axillary lymph node metastases in breast cancer. Preoperative radiocolloid injection with lymphoscintigraphy (PL) is performed before SLNB. Few comparisons between 1- and 2-day PL protocols exist. Opponents of a 2-day protocol have expressed concerns of radiotracer washout to nonsentinel nodes. Proponents cite lack of scheduling conflicts between PL and surgery. A total of 387 consecutive patients with clinically node-negative breast cancer underwent SLNB with PL. Lymphoscintigraphy images were obtained within 30 minutes of radio-colloid injection. Axillary lymph node dissection was performed if the sentinel lymph node (SLN) could not be identified. Data were collected regarding PL technique and results. In all, 212 patients were included in the 2-day PL group and 175 patients in the 1-day PL group. Lymphoscintigraphy identified an axillary sentinel node in 143/212 (67.5%) of patients in the 2-day group and 127/175 (72.5%) in the 1-day group ( P = 0.28). SLN was identified at surgery in 209/212 (98.6%) patients in the 2-day group and 174/175 (99.4%) in the 1-day group ( P = 0.41). An average of 3 SLN was found at surgery in the 2-day group compared with 3.15 in the 1-day group ( P = 0.43). SLN was positive for metastatic disease in 54/212 (25.5%) patients in the 2-day group compared with 40/175 (22.9%) in the 1-day group ( P = 0.55). A 2-day lymphoscintigraphy protocol allows reliable detection of the SLN, of positive SLN and equivalent SLN harvest compared with a 1-day protocol. The timing of radiocolloid injection before SLNB can be left at the discretion of the surgeon.

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Rate of sentinel lymph node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand

Asian Biomedicine ◽

10.5372/1905-7415.0804.322 ◽

2014 ◽

Vol 8 (4) ◽

pp. 517-524

Author(s):

Kampol Ratchaworapong ◽

Sarawut Thanawut ◽

Sirisanpang Yodavudh ◽

Suthat Chottanapund

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Cancer Patients ◽

Primary Breast Tumor ◽

Blue Dye ◽

Axillary Lymph ◽

Isosulfan Blue ◽

Breast Cancer Patients ◽

Isosulfan Blue Dye

Abstract Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques. Objective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it. Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye. Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients. Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries.

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