Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies

Abstract

BackgroundAxillary reverse mapping (ARM) is a novel technique for preserving the upper extremity lymphatic pathways during axillary lymph node surgery. However, there is no evidence of the usefulness of ARM for patients undergoing sentinel lymph node biopsy (SNB).MethodsBetween August 2009 and July 2012, 372 patients who underwent the SNB procedure for breast cancer were enrolled in this study. Using the indocyanine green fluorescence technique and indigocarmine blue dye method, we studied the relationship between the upper extremity lymphatic flow and breast sentinel node (SN). Our aim of this study was the probability of postoperative lymphedema with respect to whether the upper extremity lymphatics corresponded to the breast SN.ResultsAmong the 327 patients who underwent the SNB procedure, the upper extremity lymphatics drainage into the breast SN in 76 (23.2%; corresponding group), and only 5 patients in this group developed lymphedema. In contrast, none of the patients in the noncorresponding group developed lymphedema.ConclusionsARM during SN biopsy can identify the group of patients who are at high risk for developing lymphedema. More risk-focused guidance should be used for these patients. J. Surg. Oncol. 2014 109:612–615.

Is axillary reverse mapping feasible in breast cancer patients?

“…The identification rates of ARM nodes were lower in the SLN biopsy field when compared with those in the ALND field. This is consistent with the results of other studies 11,12,20,30,34 (Table 2).…”

“…Boneti et al 34 reported that crossover (ARM node ¼ SLN) occurred in only 6 (2.8%) of 218 patients, although ARM lymphatics were near or within the SLN biopsy field in 40.6% of patients. Nevertheless, other investigators reported concordance rates of 7.2%~28% between ARM nodes and SLN 14,16,19,20,26,27,30 (Table 2). In our recent study using fluorescence imaging, the ARM nodes were SLN-ARM nodes in 64 (27%) of 238 patients (unpublished data).…”

“…In several studies, lymphedema was evaluated by volumetric measurement 25,34 or arm circumference measurement of both arms. 12,19,23,30 Gennaro et al 23 performed arm circumference measurement of both arms. In their study, 45 patients underwent selective ALND where ARM nodes were preserved, and 15 patients received standard ALND with removal of the ARM nodes.…”

“…It has been suggested that the connection between the lymphatic drainages from the breast and arm would lead to lymphedema even in patients undergoing only SLN biopsy. 29,30 However, the removal of one converged SLN-ARM node does not always cause arm lymphedema, because there are multiple lymphatic channels from the arm. Han et al 19 reported that arm circumference was not significantly different between the ARM node preserved group and unpreserved group after SLN biopsy (23% versus 40%).…”

Optimization of sentinel lymph node mapping in bladder cancer using near-infrared fluorescence imaging

“…Cystoscopic mucosal injection with distension of the bladder (cases [9][10][11][12][13][14][15][16][17][18][19][20]. After cystoscopic mucosal injection and filling of the Preoperative tumour stage of based on cystoscopy biopsy.…”