Axillary Reverse Mapping in breast cancer patients

Axillary lymph node dissection (ALND) is often associated withsome arm side effects and lymphedema is the major morbidity after thisprocedure. As we know upper extremity and the breast lymphatic drainage canbe identified as separate anatomic structures in most patients within the axilla.distinguishing the lymphatic channels draining the arm from those draining thebreast using the so-called axillary reverse mapping (ARM) technique canminimized arm lymphedema in theory.Methods: This prospective study from Feb 2009 to May 2012 included10patients diagnosed with breast cancer and clinically N1 axillary involvementwho candidate for ALND. After opening the axillary cavity, 2 to 5 mL of bluedye was injected subcutaneously in the patient’s ipsilateral upper volar surfaceof the arm for localization of lymphatic draining the arm (ARM).In ALND theblue lymphatics and blue nodes were preserved if possible.Results: Lymphatics draining the arm were very close or in the ALND field in70% (7of10) of the patients. In our study ARM demonstrated that armlymphatics do not cross over with the breast drainage in 30 %( 3of10) of thepatients.Conclusion: although ARM procedure has a steep learning curve, ARMlymphatics vary significantly from patient to patient and need larger volumesize of patients for better outcomes. Limitations of this procedure are noticeablecrossover rate or juxtaposed lymphatic channels in some cases.