Abstract
Introduction
Axillary reverse mapping (ARM) procedure is useful in reducing lymphedema. However,
concerns regarding oncologic safety have limited the adoption of the ARM procedure.
This study aimed to evaluate the involvement of ARM nodes in node-positive breast
cancer patients.
Materials and methods
Two hundred twenty-three node-positive patients were enrolled in this study: 90 were
clinically node-negative, but had one or more positive sentinel lymph nodes (SLNs)
(SLN-positive group); 68 were clinicopathologically node-positive (CpN-positive group);
and 65 had confirmed nodal involvement and received neoadjuvant chemotherapy (NAC)
(NAC group). All patients underwent axillary lymph node dissection with fluorescent
ARM.
Results
ARM nodes were involved in 33 (36.7%) patients of the SLN-group. Residual ARM nodes
after SLN biopsy were involved in 11 patients (12.2%), including 5 patients (19.2%)
with crossover type nodes and 6 patients (9.4%) with non-crossover type nodes. However,
the difference in involvement rates between the two types was not high enough to be
significant. Of these 11 patients, moreover, four patients had three or more than
3 involved SLNs. On the other hand, the involvement rate of ARM nodes in the NAC group
was significantly lower than that of the CpN-positive group (35.4% vs. 64.7%: p < 0.01).
Despite lower involvement, the risk of metastases in the ARM nodes was still too high
to spare ARM nodes in both the NAC group and CpN-positive group.
Conclusions
Suspicious or involved ARM nodes should be removed even when detected in ARM procedure,
particularly in NAC-group and CpN-positive-group patients.
Keywords
Abbreviations:
ARM (axillary reverse mapping), NAC (neoadjuvant chemotherapy), SLN (sentinel lymph node), ALND (axillary lymph node dissection), ALN (axillary lymph node), ICG (indocyanine green), BCS (breast conserving surgery), FNAC (fine needle aspiration cytology), FEC (fluorouracil, epirubicin and cyclophosphamide), DOC (docetaxel), H & E (hematoxylin and eosin), CpN-positive (clinicopathologically node-positive)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 18, 2023
Accepted:
May 18,
2023
Received in revised form:
March 27,
2023
Received:
January 30,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
