Abstract P1-01-05: The Efficacy of Arm Node Preserving Surgery Using Axillary Reverse Mapping for Preventing Lymphedema in Patients with Breast Cancer: The results from a 2-year follow-up

Abstract

Abstract Purpose: The axillary reverse mapping (ARM) technique to identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) was developed to prevent lymphedema. In our previous study, we evaluated the incidence of lymphedema after ARM and the difference in arm circumference between arm node preserved group and unpreserved group, after short term follow up. The purpose of this study was to investigate the location and metastatic rate of the arm node, and to evaluate the further follow-up results of the differences in arm circumference after arm node preserving surgery. Methods: From January 2009 to December 2011, 116 breast cancer patients who underwent ARM were included. Blue-dye (2.5ml) was injected into the ipsilateral upper-inner arm. At least 20 minutes after injection, SLNB or ALND was performed and blue-stained arm nodes and/or lymphatics were identified. Patients were divided into two groups, an arm node preserved group (87 patients had ALND, 10 patients had SLNB) and an unpreserved group (15 patients had ALND, 4 patients had SLNB). The difference in arm circumference between preoperative and postoperative time points was checked in both groups. Results: The mean number of identified blue stained arm nodes was 1.41±0.66. The mean follow up period was 16.24(3∼24)months. In the majority of patients (86.2%), arm nodes were located between the lower level of the axillary vein and just below the second intercostobrachial nerve. The location of the arm node was the inferolateral side of axillary and thoracodorsal vessels in 62 patients (53.4%), the inferomedial side in 46 patients (39.7%), the superolateral side in 5 patients (4.3%), and the superomedial side in 3 patients (2.6%) In the arm node unpreserved group, 5 patients (4.3%) had metastasis in their arm node. When comparing between arm circumferences in ipsilateral upper-extremity of the arm node preserved group and unpreserved group, in the SLNB group, there was no significant difference. But in the ALND group, the arm circumference changes of the arm node unpreserved group were bigger than that of the preserved group (0.50±1.15 vs 0.16±0.76, p = 0.066). There were no lymphedema cases among the arm node preserved group, but one lymphedema developed in the unpreserved group(5.2%). There was no locoregional recurrence in both group in follow up periods. Conclusion: After further follow-up, this study showed some differences in arm circumference between two groups. Arm node preserving was possible in all breast cancer patients with identifiable arm nodes, during ALND or SLNB, except for those with high surgical N stage, and lymphedema and locoregional recurrences did not develop in patients with arm node preserving surgery. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-05.