Axillary reverse mapping in patients with breast cancer: Is it oncologically safe?

Ngui, Nicholas K.; French, James; Kilby, Christopher J.; Pathmanathan, Nirmala; Elder, Elisabeth

doi:10.1002/jso.24231

Cited by 20 publications

(22 citation statements)

References 27 publications

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“…Twenty-nine articles published between January 2007 and January 2020 describing studies of 4954 patients were included in this meta-analysis [ 1 , 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. These included four randomized controlled trials [ 1 , [20] , [21] , [22] ] and 25 prospective non-randomized studies [ 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [23] , [24] , [25] ].…”

Section: Resultsmentioning

confidence: 99%

“…(2016) [ 33 ] Prospective India ALND alone (50) Radioisotope ALND: 94%(47/50) NA 11%(5/47) NA NA Moderate quality 04/2012–08/2012 Ngui et al. (2016) [ 26 ] Prospective Australia ALND alone (87) Blue dye ALND: 77%(67/87) 9%(3/32) 27%(18/67) NA NA Moderate quality 06/2012–12/2014 Noguchi et al. (2016) [ 2 ] Prospective Japan SLNB with or without ALND(292); ALND with SLNB (48) Blue dye + fluorescence SLND: 31% (90/292) ALND: 86%(36/42) 27%(77/286) 21%(19/90) SLNB: 1%(2/244) 45 months Moderate quality 06/2012–12/2014 Nos et al.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies investigated the crossover rate between the SLN and ARM lymph nodes [ 2 , 6 , 9 , 11 , 14 , 15 , 18 , 19 , [24] , [25] , [26] ]; the overall pooled crossover rate was 12% (95% CI 6%–19%, I 2 = 93.7%, P < 0.05) ( Fig. 4 A).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies investigated the SLN + axillary status ARM metastatic rate [ 9 , 11 , 24 , 26 , 34 ]. Regardless of the presence of additional metastases in other lymph nodes extracted during ALND, our pooled ARM node metastasis rate within the SLN + patient group was 22% (95% CI 13%–33%, I 2 = 22.8%, P = 0.269) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

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Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Wijaya¹,

Peng²,

et al. 2020

The Breast

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Background The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was developed to prevent breast-cancer related lymphedema (BCRL) remains controversial. Methods A comprehensive search of Medline Ovid, Pubmed, Web of Science and the Cochrane CENTRAL databases was conducted from the inception till January 2020. The key word including “breast cancer”, “axillary reverse mapping”, and “lymphedema”. Stata 15.1 software was used for the meta-analysis. Results As a result, twenty-nine related studies involving 4954 patients met our inclusion criteria. The pooled overall estimate lymphedema incidence was 7% (95% CI 4%–11%, I 2 = 90.35%, P < 0.05), with SLNB showed a relatively lower pooled incidence of lymphedema (2%, 95% CI 1%–3%), I 2 = 26.06%, P = 0.23) than that of ALND (14%, 95% CI 5%–26%, I 2 = 93.28%, P < 0.05) or SLNB and ALND combined (11%, 95% CI 1%–30%). The ARM preservation during ALND procedure could significantly reduce upper extremity lymphedema in contrast with ARM resection (OR = 0.27, 95% CI 0.20–0.36, I 2 = 31%, P = 0.161). Intriguingly, the result favored ALND-ARM over standard-ALND in preventing lymphedema occurrence (OR = 0.21, 95% CI 0.14–0.31, I 2 = 43%, P = 0.153). The risk of metastases in the ARM-nodes was not significantly lower in the patients who had received neoadjuvant chemotherapy, as compared to those without neoadjuvant treatment (OR = 1.20, 95% CI 0.74–1.94, I 2 = 49.4%, P = 0.095). Conclusions ARM was found to significantly reduce the incidence of BCRL. The selection of patients for this procedure should be based on their axillary nodal status. Preoperative neoadjuvant chemotherapy has no significant impact on the ARM lymph node metastasis rate.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Wijaya¹,

Peng²,

et al. 2020

The Breast

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“…However, we found only a few studies had described the distribution pattern of SLNs in axillary tissues. [ 22 – 24 ] For example, Clough et al [ 25 ] explored the distribution of SLNs in axillary tissues in 242 breast cancer patients, using blue dye or radioisotope to trace the SLNs. They found that the majority of SLNs were located at the medial part of the axilla, alongside the lateral thoracic vein.…”

Section: Discussionmentioning

confidence: 99%

Retrospective observational study about reducing the false negative rate of the sentinel lymph node biopsy

Zhou

Du²,

Zhang³

et al. 2017

Medicine

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Reducing the false negative rate of sentinel lymph node biopsy (SLNB) for breast cancer patients has always been a focus of clinical research. We aimed to map the sentinel lymph nodes (SLNs) in detail, and analyze the factors related to SLNs located at locations that are often ignored by surgeons, to reduce the rate of false negatives from SLNB. A retrospective analysis involving 545 breast cancer patients who underwent SLNB in west China hospital between August 2010 and February 2016 was performed. Blue dye, radioisotope, or combined methods were used for tracing SLNs. Using blue dye, radioisotope, and a combination of blue dye and radioisotope successfully traced SLNs in 479, 507, and 525 patients, the detection rate was 88.2%, 93.9%, and 97.4%, respectively. Among the 1559 detected SLNs, 139 (9.6%) were located at the latissimus dorsi lateral margin, and 108 (6.9%) were located at level 2. Subcutaneous injection of radioisotope (P = .004) and intradermal injection of blue dye (P = .002) were independent factors associated with SLNs distributed at level 2 and the latissimus dorsi lateral margin, respectively. It was noteworthy that 2 of 7 patients had skipping metastasis in level 2, so subcutaneous injection of the isotope is strongly recommended for tracing SLNs distributed in level 2 because of the possibility of skipping metastasis. Though intradermal injection of blue dye was superior methods for tracing SLNs located at the latissimus dorsi lateral margin, we surprisingly found those patients with metastasis to the latissimus dorsi lateral margin nodes also could have metastasis to level 1 (expect for the latissimus dorsi lateral margin) nodes, it seemed that maybe there is no need to excise SLNs at the latissimus dorsi lateral margin in SLNB, whether such nodes should be regarded as useful for SLNB still needs to be determined by further large, multicenter clinical studies.

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Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

Coroneos

Woodward

Wong

et al. 2020

Journal of Surgical Oncology

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Background This study characterizes the physiological drainage of the normal upper extremity using single‐photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (ARM). Methods A consecutive series of patients assessed with SPECT/CT lymphoscintigraphy ARM of the upper extremity were included. Anatomical localization of the axillary sentinel lymph nodes (SLN) was completed in normal axillae in relation to consistent anatomic landmarks. Retrospective case note analysis was performed to collect patient demographic data. Results A total of 169 patients underwent SPECT/CT lymphoscintigraphy, and imaging of 182 normal axillae was obtained. All patients (100%) had an axillary SLN identified: 19% had a single contrast‐enhanced SLN in the axilla and the remainder had multiple. The SLN(s) of the upper extremity was located in the upper outer quadrant (UOQ) of the axilla in 97% of cases (177 axillae). When the SLN(s) was found in the UOQ of the axilla, second‐tier lymph nodes were found predominantly in the upper inner quadrant (50% of cases). Conclusions The upper extremity SLN(s) is located in a constant region of the axilla. This study provides the most complete investigation to date and results can be directly applied clinically to ARM techniques and adjuvant radiation planning.

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Axillary reverse mapping in patients with breast cancer: Is it oncologically safe?

Cited by 20 publications

References 27 publications

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Retrospective observational study about reducing the false negative rate of the sentinel lymph node biopsy

Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

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