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Axillary reverse mapping using a fluorescence imaging system in breast cancer.

Miki Noguchi1, Masakuni Noguchi, Yasuharu Nakano

  • 1Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Ishikawa, Japan. nogumasa@kanazawa-med.ac.jp

Journal of Surgical Oncology
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The axillary reverse mapping (ARM) procedure may allow sparing of ARM nodes during axillary lymph node dissection (ALND) in breast cancer patients. Further research is needed to confirm the oncologic safety of this approach.

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Area of Science:

  • Surgical Oncology
  • Breast Cancer Research
  • Lymphatic System Imaging

Background:

  • The axillary reverse mapping (ARM) procedure is predicated on distinct lymphatic drainage pathways between the upper arm and the breast.
  • The oncologic safety of the ARM procedure remains undetermined.

Purpose of the Study:

  • To evaluate the feasibility and oncologic safety of the axillary reverse mapping (ARM) procedure in breast cancer patients undergoing axillary lymph node dissection (ALND).

Main Methods:

  • Utilized a fluorescence imaging system to identify ARM nodes.
  • Performed ALND with separate removal of ARM nodes in patients with clinically involved axillary lymph nodes.
  • Conducted sentinel lymph node (SLN) biopsy for clinically uninvolved nodes, proceeding to ALND with ARM node removal if SLN was positive.

Main Results:

  • ARM nodes were identified in 85% of patients undergoing ALND and 11 had tumor involvement.
  • In patients undergoing SLN biopsy, ARM nodes were identified in 43% and were concordant with SLN in 27 cases.
  • When ARM nodes were distinct from positive SLNs in patients who underwent ALND, they were found to be tumor-free.

Conclusions:

  • Sparing of ARM nodes during ALND may be feasible in select breast cancer patients, particularly those with a positive SLN.
  • The findings suggest potential for reducing morbidity associated with complete axillary lymph node dissection.