Indocyanine Green Fluorescence-Guided Axillary Reverse Mapping for Axillary Lymph Node Dissection in Breast Cancer:...

Area of Science:

• Oncology
• Surgical Oncology
• Lymphedema Research

Background:

• Lymphedema is a common complication after axillary lymph node dissection (ALND).
• Axillary reverse mapping (ARM) aims to preserve upper limb lymphatic drainage during ALND to prevent lymphedema.
• Concerns about tracer reliability and oncological safety have limited ARM adoption.

Purpose of the Study:

• To assess the feasibility of indocyanine green (ICG) fluorescence-guided ARM during ALND.
• To identify predictive factors for metastasis in ARM nodes.

Main Methods:

• Prospective trial involving 100 patients undergoing ALND for breast cancer.
• ICG injected into the upper arm to visualize lymphatics via near-infrared fluorescence.
• ARM nodes categorized anatomically and analyzed for histopathological metastasis.

Main Results:

• ARM nodes were identified in 95% of patients, with 68.5% in the upper lateral axilla.
• Metastatic involvement of ARM nodes was observed in 18.9% of cases.
• Tumor size ≥ 50 mm and higher nodal stage (N2/N3) independently predicted ARM node metastasis.

Conclusions:

• ICG-guided ARM is a feasible technique for ALND.
• The risk of ARM node metastasis in advanced breast cancer suggests routine preservation may be unsafe.
• Alternative strategies like lymphaticovenous anastomosis are needed to mitigate lymphedema risk.