Axillary reverse mapping in patients with breast cancer: Is it oncologically safe?

• Published in: Journal of surgical oncology Vol. 113; no. 7; pp. 726 - 731
• Main Authors: Ngui, Nicholas K., French, James, Kilby, Christopher J., Pathmanathan, Nirmala, Elder, Elisabeth E.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Axilla; axillary reverse mapping; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Lobular - pathology; Carcinoma, Lobular - surgery; Coloring Agents; Female; Humans; Lymph Node Excision - methods; Lymph Nodes - diagnostic imaging; Lymph Nodes - surgery; Lymphatic Metastasis; lymphedema; Middle Aged; Prospective Studies; Rosaniline Dyes; sentinel lymph node biopsy; breast cancer; sentinel lymph node biopsy; lymphedema; axillary reverse mapping
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24231

Background Axillary reverse mapping (ARM) is a technique used to identify the lymphatics draining the arm. The aim of this study was to examine the prevalence and predictors of ARM node metastases in breast cancer patients undergoing an axillary lymph node dissection (ALND). Methods A total of 87 patients were enrolled in this study. Patent V Blue dye was injected in the upper arm for ARM node localization. All patients had an ALND with the identified ARM node removed and sent separately for histologic analysis. Results Of 67 (77%) patients in whom an ARM node was identified, 49 (73%) were negative and 18 (27%) were positive for metastases on final histopathology. Positive ARM node status was significantly associated with advanced axillary disease, and larger primary cancers. Patients requiring a completion ALND due to a positive sentinel lymph node biopsy (SLNB) with non‐suspicious ARM nodes during surgery did not have ARM node metastases. Conclusions There is a high risk of ARM node involvement, approximately a quarter, in patients with preoperatively known lymph node metastases from breast cancer. However, it may be safe to preserve a clinically non‐suspicious ARM node in patients with a positive SLNB who require a completion ALND. J. Surg. Oncol. 2016;113:726–731. © 2016 Wiley Periodicals, Inc.