Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients

With the purpose of minimizing arm lymphedema after axillary staging surgeries in breast cancer patients, the axillary reverse mapping (ARM) technique has been developed to identify and preserve arm drainage system during axillary surgery. This study aimed to clarify risk factors for metastasis in arm lymphatic drainage system in breast cancer patients with clinically negative axillary nodes.

Sixty-nine patients who underwent successful both sentinel lymph node (SLN) biopsy (SLNB) and ARM from October 2009 to August 2010 were enrolled in this study. Radioactive tracer was used for SLN localization and blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent for pathological assessment.

ARM nodes metastasis occured in 6 of 69 patients. Age, pathological tumor size (pT) and pathological lymph node status (pN) were not associated with ARM nodes metastasis (P > 0.01). Interestingly, in these 6 patients, all metastatic ARM nodes coincided with SLN-ARM nodes (hot SLN and blue ARM node were the same lymph node). In 50 of 69 patients whose ARM nodes did not coincided with SLNs, all ARM nodes were negative, even in 12 patients with metastatic SLNs.

Crossover between breast and ipsilateral arm lymphatic drainage system contributes for ipsilateral arm lymph node metastasis. When ARM and SLNB are simultaneously performed in a patient, selectively preservation of the ARM nodes that do not coincided with SLNs would be safe, even if the SLNs are positive. Pathological lymph node status does not account for the occurrence of metastasis in ARM nodes. ARM nodes could be preserved safely, independent of the pathological lymph node status.