Abstract
The concept of reverse axillary mapping originated with the main purpose of reducing lymphedema. In this study, we test the advantage of reverse axillary mapping to delineate the arm-draining lymph nodes and their involvement in various stages of breast carcinoma. In this study, we also attempt to redefine the template for axillary dissection in breast cancer.During the period of September 30, 2020, to August 30, 2021, 46 patients were recruited to undergo a procedure in which isosulfan blue dye was injected into the upper arm and the axilla was explored to isolate the lymph nodes. The lymph nodes were submitted for examination histopathologically.The results conclusively showed that axillary lymph node metastasis was only influenced by the advanced stage of the disease (p=0.014) and the visualization of the lymphatics was independent of the stage, type of surgery, decubitus, or age.The study conclusively shows that attempts to preserve the upper limb-draining nodes in advanced stages would be futile and the preservation of such lymph nodes should be limited to the early stages of breast cancer.
Highlights
In the management of operable breast cancer, the axillary lymph node status is the most important prognostic factor
The hypothesis is that the upper limb lymphatics are delineated by blue dye injected into the medial arm during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), which can be preserved, thereby preventing upper limb lymphedema
Inclusion criteria were as follows: patients planned for breast conservation surgery (BCS) or modified radical mastectomy (MRM); patients aged over 18 years; patients willing to participate in the study; patients with operable breast cancer (T1-4b, N0-1, M0) upfront or post-neoadjuvant therapy; and patients undergoing ALND post lumpectomy
Summary
In the management of operable breast cancer, the axillary lymph node status is the most important prognostic factor. Among the complications associated with SLNB and ALND, upper limb lymphedema is the most distressing, occurring in 7% and 30% [1,2]. The hypothesis is that the upper limb lymphatics are delineated by blue dye injected into the medial arm during SLNB or ALND, which can be preserved, thereby preventing upper limb lymphedema. The lymph node draining the upper limb appears as a blue node called the axillary reverse mapping (ARM) node and has been reported in the early studies as not harboring metastatic disease [3,4,5]. Some studies like Ponzone et al reported that approximately 10% of patients with extensive nodal diseases had ARM node involvement [6]
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