The involvement of axillary reverse mapping nodes in patients with clinically node-negative breast cancer

Noguchi, Masakuni; Inokuchi, Masafumi; Yokoi-Noguchi, Miki; Morioka, Emi

doi:10.1007/s12282-021-01300-6

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…The fluorescent imaging technique is highly sensitive in identifying ARM nodes. In a study by Noguchi et al [48], 507 patients with cN0 breast cancer underwent SLN biopsy with the ARM procedure using fluorescence dye. Although ARM nodes were involved in 18 of the 65 patients in which ARM nodes were identified, in 14 (78%) of these patients, the involved ARM nodes were identical to the SLNs identified.…”

Section: Conservative Alnd With Axillary Reverse Mapping (Arm)mentioning

confidence: 99%

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Noguchi,

Inokuchi,

Yokoi-Noguchi

et al. 2023

Cancers

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Axillary lymph node dissection (ALND) has been associated with postoperative morbidities, including arm lymphedema, shoulder dysfunction, and paresthesia. Sentinel lymph node (SLN) biopsy emerged as a method to assess axillary nodal status and possibly obviate the need for ALND in patients with clinically node-negative (cN0) breast cancer. The majority of breast cancer patients are eligible for SLN biopsy only, so ALND can be avoided. However, there are subsets of patients in whom ALND cannot be eliminated. ALND is still needed in patients with three or more positive SLNs or those with gross extranodal or matted nodal disease. Moreover, ALND has conventionally been performed to establish local control in clinically node-positive (cN+) patients with a heavy axillary tumor burden. The sole method to avoid ALND is through neoadjuvant chemotherapy (NAC). Recently, various forms of conservative axillary surgery have been developed in order to minimize arm lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, conventional ALND may not be necessary in either cN0 or cN+ patients. Further studies with a longer follow-up period are needed to determine the safety of conservative axillary surgery.

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Section: Conservative Alnd With Axillary Reverse Mapping (Arm)mentioning

confidence: 99%

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Noguchi,

Inokuchi,

Yokoi-Noguchi

et al. 2023

Cancers

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“…[ 14 ] The most crucial point is the crossover between arm and breast sentinel nodes ranging up to 28%. [ 15 , 16 ] Therefore, we sought for a simple and safe method to detect SLN with dual agent mapping and reserve ARM nodes identified with ICG, for patients who converted to clinically nod negative after NST. The purpose of this study was to assess the crossover rate and involvement of ARM nodes in patients with clinically node negative disease after NST who underwent dual agent SLNB.…”

Section: Introductionmentioning

confidence: 99%

Triple mapping for axillary staging after neoadjuvant therapy: Axillary reverse mapping with indocyanine green and dual agent sentinel lymph node biopsy

et al. 2022

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Axillary staging is 1 of the major issues of current breast cancer management after neoadjuvant systemic therapy (NST). Sentinel lymph node biopsy (SLNB) is an option for clinically node negative patients. Axillary reverse mapping (ARM) was introduced to identify and preserve the lymphatic drainage from the arm. The aim of the presented study is to employ triple mapping (radiocolloid, blue dye and indocyanine green [ICG]) to assess the crossover rate and metastatic involvement of ARM nodes after NST. Clinically node positive patients before NST who were converted to N0 and scheduled for targeted axillary dissection were included. sentinel lymph node (SLN) mapping was performed via dual agent mapping. ICG was used for ARM procedure. Blue, hot and fluorescent nodes and lymphatics were visualized in the axilla using infrared camera system and dual opto-nuclear probe (Euoroprobe3). Fifty-two patients underwent targeted axillary dissection and ARM procedures 12 out of whom had axillary node dissection. 45 of the 52 patients had at least 1 hot or blue SLN identified intraoperatively. Of these, 61.5% cases had hot SLNs, 42.3% had hot and blue, 15.4% had hot/blue/fluorescent, 7.7% had blue/fluorescent, 6 11.5% had hot/fluorescent and 7 13.5% had only clipped nodes. The overall identification rate of ARM-nodes by means of ICG technique was 86.5%. Overall crossover of ARM nodes with SLNs was determined in 36.5%. The ICG intensity was found to be higher in both hot and blue SLNS (8 out of 18 ICG positive cases, 44.4%). In 3 of 52 patients (5.7%) metastatic SLNs were hot or blue but fluorescent which predicts metastatic involvement of the ARM-nodes. More than 1-third of the patients revealed a crossover between arm and breast draining nodes. The higher observed rate of overlap might partially explain why more patients develop clinically significant lymphedema after NST even after sentinel lymph node biopsy alone. The triple mapping provides valuable data regarding the competency of lymphatic drainage and would have the potential to serve selecting patients for lymphovenous by-pass procedures at the index procedure. NST reduces the metastatic involvement of the ARM nodes. However, conservative axillary staging with sparing ARM nodes after NST necessitates further studies with larger sample size and longer follow-up.

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Conservative axillary surgery is emerging in the surgical management of breast cancer

et al. 2022

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The involvement of axillary reverse mapping nodes in patients with clinically node-negative breast cancer

Cited by 5 publications

References 27 publications

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Triple mapping for axillary staging after neoadjuvant therapy: Axillary reverse mapping with indocyanine green and dual agent sentinel lymph node biopsy

Conservative axillary surgery is emerging in the surgical management of breast cancer

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