Abstract

BackgroundThe axillary reverse mapping (ARM) procedure can distinguish lymphatics draining the arm from those draining the breast. It has been proposed to preserve lymphatic drainage of the upper limbs and reduce the incidence of upper limb lymphedema during breast cancer surgery. The aim of our study was to assess the feasibility of ARM in modified radical mastectomy and to evaluate its effect on prevention of lymphedema. Patients and MethodsFrom January 2012 to March 2014, a prospective study was performed in 265 breast cancer patients who underwent modified radical mastectomy. Patients were divided into 2 groups, 127 patients (47.93%, control group) received a traditional axillary lymph node dissection (ALND), and 138 patients (52.07%, experimental group) received ARM preservation of the nodes and lymphatics during ALND. Radioactive tracer and methylene blue were used for ARM of the nodes and lymphatics. All of the identified ARM nodes were diagnosed using fine needle aspiration cytology for assessment of metastatic status. All resected axillary lymph nodes were conducted in a pathology examination to evaluate tumor metastasis. Data were collected on variations in identification of the ARM nodes and lymphatics, the metastasis of ARM nodes, and the occurrence of lymphedema. ResultsIn the experimental group, the ARM procedure was successfully conducted in 129 cases (93.48%). ARM nodes metastasis occurred in 11 patients (8.53%). The median follow-up time was 20 months, at the last evaluation there were 42 patients who developed upper limb lymphedema in the control group (33.07%), and in the experimental group the incidence of lymphedema was 5.93% (7/118; P < .001). None of the patients had nodal relapses during the follow-up time. ConclusionARM appears to be a feasible technique with which to identify upper arm nodes and lymphatics during the modified radical mastectomy procedure. The incidence of lymphedema can be decreased in patients with use of the ARM procedure.

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