Axillary Reverse Mapping: A Potentially Safe Procedure in Oncology

Background: In an attempt to reduce the risk of developing lymphedemafollowing breast cancer surgery, some researchers suggested that by identifyingand preserving the lymphatic plexus which drains ipsilateral arm we can minimizethe risk of lymphedema. The procedure is known as axillary reverse mapping(ARM). In the current study, we investigated the oncological safety of thistechnique.Methods: A total of ۶۰ patients who were undergoing axillary lymph nodedissection were involved. The indications for axillary dissection were whetherclinically node-positive axilla or positive sentinel lymph node biopsy. ARM wasperformed by injecting ۲ ml of methylene blue subcutaneously in the upper andmedial part of ipsilateral patients’arm along the intermuscular groove.Results:ARM nodes were identified by means of methylene blue injection in۵۱(۸۵%) patients (identification rate = ۸۵%). For the subgroup of clinicallypositive axillary lymph nodes, identification rate was ۹۳.۱%, and thecorresponding figure was ۷۷.۴% for positive SLNB group (P = ۰.۱۴۸).Pathological evaluation of harvested ARM nodes demonstrated metastaticinvolvement in ۸(۲۷.۵%) and ۱(۳.۲%) patients in clinically positive and SLNBpositive groups respectively (P= ۰.۰۲۶).Conclusions: Based on the findings of this study it seems thatARM could beconsidered as a safe procedure in patients who are a candidate for ALND whenSLNB is positive. In contrast, in patients with clinically positive axillary nodes,there is a considerable risk of tumoral metastasis inARMnodes.

Keywords:

SLNB , oncological safety , tumoral involvement , axillary reverse mapping