Related Experiment Video
Updated: May 22, 2026
03:07
Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
Published on: August 19, 2025
ARM: axillary reverse mapping - the need for selection of patients
P D Gobardhan1, J H Wijsman, Th van Dalen
1Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands. pgobardhan@hotmail.com
Summary
Axillary reverse mapping (ARM) is a feasible technique for breast cancer staging. Metastatic involvement in ARM-nodes was higher in patients with confirmed axillary metastases than in those with positive sentinel lymph nodes.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Axillary reverse mapping (ARM) differentiates arm lymphatic drainage from breast lymphatic drainage.
- Evaluating the feasibility and metastatic involvement of ARM-nodes is crucial for breast cancer staging.
Purpose of the Study:
- To assess the technical feasibility of Axillary Reverse Mapping (ARM).
- To determine the proportion of metastatic involvement in ARM-nodes.
- To compare metastatic rates in ARM-nodes between different patient groups.
Main Methods:
- Patients with invasive breast cancer requiring axillary lymph node dissection (ALND) were enrolled.
- Two groups were distinguished: tumor-positive sentinel lymph node (SLN(+)) and cytologically proven positive axillary nodes (CP-N(+)).
- ARM was performed using blue dye, with ARM-nodes identified and removed before ALND.
Main Results:
- 93 patients underwent ARM between October 2009 and June 2011.
- Visualization rates of ARM-nodes were high and similar between SLN(+) (86%) and CP-N(+) (94%) groups.
- Metastases were found in 22% of ARM-nodes in the CP-N(+) group, versus 0% in the SLN(+) group (P = 0.001).
- Neoadjuvant systemic therapy reduced the risk of additional axillary lymph node metastases (24.6% vs 44.4%, P = 0.046).
Conclusions:
- Axillary reverse mapping (ARM) is technically feasible with a high visualization rate.
- Metastatic involvement in ARM-nodes is significantly higher in patients with preoperatively confirmed axillary metastases compared to those with a positive SLN.
- ARM may be suitable for patients with SLN metastases and potentially for those with confirmed axillary metastases receiving neoadjuvant chemotherapy.
