Arm Nodes Research Articles

P3-07-44: Feasibility of Axillary Reverse Mapping during Sentinel Lymph Node Biopsy in Breast Cancer.

Abstract Background: The axillary reverse mapping (ARM) procedure is based on the hypothesis that the lymphatic drainage from the upper arm is different from that of the breast. However, the oncologic safety of the procedure has not yet been determined. Methods: The ARM nodes were identified using a fluorescence imaging system. Sentinel lymph node (SLN) biopsy was performed in patients with clinically uninvolved nodes. If the SLN was positive, ALND was performed with removal of ARM nodes. Otherwise, the identified ARM nodes were preserved unless they were the same as the SLN. Results: The ARM node was identified in 30 of 91 patients who underwent SLN biopsy, and it was the same as the SLN in 23 patients. However, in 13 patients with a positive SLN who subsequently underwent ALND, ARM nodes were tumor-free when they were not the same as the positive SLN. Conclusions: There are limits to the principle of non-overlap between breast and arm nodes. However, it may be feasible to spare ARM nodes during ALND in patients with clinically negative nodes. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-44.

Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer

The ARM technique was proposed to prevent arm lymphedema after ALND and/or SLN biopsy. However, several problems remain to be resolved in the practical application of this technique. The fluorescent ARM nodes and/or lymphatics were identified using a fluorescence imaging system with subdermal injection of indocyanine green into the upper limb. ALND was performed in patients with clinically involved nodes, and the ARM nodes were separately removed during ALND. SLN biopsy was performed in patients with clinically uninvolved nodes. If SLN was positive, ALND was performed with removal of ARM nodes. Otherwise, identified ARM nodes were preserved unless they were the same as SLN. ARM nodes and/or lymphatics were identified in 7 (88%) of 8 patients who underwent ALND, whereas they were identified in 9 (75%) of 12 patients who underwent SLN biopsy alone. ARM nodes were involved with tumors in 3 (43%) of the former patients, and SLN was the same as the ARM node in 2 (14%) of 14 patients who underwent SLN biopsy. Fluorescence imaging was sensitive for identification of ARM nodes and/or lymphatics. However, further studies are needed before efforts to preserve these nodes can be safely implemented.

再発転移した手の放射線癌 手の放射線癌の１例 再発を繰り返し６年経過した症例

We reported a case of recurrent radiationinduced squamous cell carcinoma of theright ring finger of a 65-yearold orthopedist. He received his first amputation inanother hospital in 1989. One year later, recurrence on the stump occured and digitalray amputation was performed in July, 1992. But four months later recurrence on thefourth metacarpal region of the dorsal side was noticed. In May, 1993, we completelyremoved this tumor and dissected axillary lymph nodes after continuous cutaneousinfusion of PEP at a total dose of 50mg. Three months after surgery, epitrochlearlymph nodes metastases ocurred. Radiotherapy only was performed because thepatient refused amputation of the right upper arm. The treatment was not radical.It is difficult to decide to amputate the upper arm, taking into consideration of thequality of life of the patient. But amputation of the upper arm and dissection ofaxillary lymph nodes for a recurrent tumor of a hand would be a better treatment.