Preservation of lymphatic drainage from arm in breast cancer surgery: is it safe?.

Abstract

Abstract Abstract #201 Purpose: Sentinel lymph node biopsy (SLNB) for breast cancer was introduced to prevent the high morbidity seen with Axillary lymph node dissection (ALND). Although multiple comparison studies have confirmed that SLNB consistently has lower morbidity and lymphedema rates than ALND; it is still clinically significant ranging from 0∼13%. The aim of this study was to confirm the feasibility of the technique, so called Axillary reverse mapping (ARM), and to test the hypothesis that arm lymphatics are never involved by the metastatic process of breast cancer.
 Methods: We reviewed prospectively maintained database of 129 patients who operated for primary breast cancer since June 2007. Sentinel lymph nodes (SLNs) were identified by using a radiolabeled isotope (TC99m-phytate or human serum albumin). Under general anesthesia, 2.5∼3 mL of blue dye was injected in the upper inner arm along the medial intramuscular groove of ipsilateral arm in order to locate the draining lymphatics or lymph node from the arm. We then proceeded as usual with the SLNB or ALND. During axillary procedure, we take the blue node (ARM node) and SLN (hot node), and both were sent to pathology department for frozen section analysis. If SLNs were positive, ALND was performed and axillary contents were sent to pathology. Histological results of ARM node were compared with that of the other nodes of the SLNB or ALND.
 Results: The mean age of patients was 48.3 years old (rang 27∼73). Surgeries included 41 mastectomies, 80 breast conserving surgeries and eight skin sparing mastectomies with immediate reconstruction. Of the 129 procedures, 81 were in SLNB (62.8%), 43 SLNB+ALND (33.3%), and five ALND. One hundred one of 129 (78.3%) blue ARM nodes were identified in the axilla. The average number of removed ARM node was 1.5 (range 1∼5). In 19 of 96 SLNB cases, the ARM nodes were hot, yielding 18.9% of concordance rate between ARM node and SLN. Among these 19 cases, seven ARM nodes contained metastasis. In one SLNB case, the metastatic ARM node was not hot. In all five ALND cases, ARM nodes were identified and one of five ARM nodes was positive for metastasis. Thus, ARM node metastasis rate of identified ARM node during ARM procedure was 8.9% (9/101).
 Conclusion: According to our study, it is thought that lymphatic drainage from arm share common lymphatic channel in axilla with lymphatic flow from breast. Therefore, intentional preservation of lymphatics or lymph node drained from arm during performing axillary surgery in breast cancer could be a dangerous one. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 201.