Reverse Axillary Mapping in Breast Cancer Using Blue Dye: A Tertiary Setup Experience

Area of Science:

• Oncology
• Surgical Oncology
• Lymphedema Research

Background:

• Lymphedema is a significant concern following breast cancer treatment.
• Reverse axillary mapping aims to improve lymph node identification and reduce lymphedema risk.
• Current axillary dissection templates may not optimally preserve lymphatic drainage.

Purpose of the Study:

• To evaluate the effectiveness of reverse axillary mapping in delineating arm-draining lymph nodes.
• To assess the involvement of these lymph nodes in various stages of breast carcinoma.
• To redefine the template for axillary dissection in breast cancer surgery.

Main Methods:

• Prospective study involving 46 breast cancer patients from September 2020 to August 2021.
• Isosulfan blue dye injected into the upper arm to visualize lymphatic pathways.
• Axillary lymph nodes were isolated and examined via histopathology.

Main Results:

• Axillary lymph node metastasis was significantly associated with advanced breast cancer stage (p=0.014).
• Lymphatic visualization was independent of disease stage, surgical type, patient position, or age.
• Reverse axillary mapping successfully delineated arm-draining lymph nodes.

Conclusions:

• Preserving upper limb-draining lymph nodes in advanced breast cancer stages is likely futile.
• Lymph node preservation should be considered primarily for early-stage breast cancer.
• Reverse axillary mapping provides valuable insights for refining axillary dissection strategies.