Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients

Background: Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphaticpathways during axillary lymph node dissection (ALND), thereby preventing lymphedemapatients with breast cancer. However, the oncologic safety of sparing the nodes identified byARM (ARM nodes), some of which are positive, has not been verified. We evaluated themetastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC)in assessing ARM node metastasis. Methods: Sixty patients with breast cancer who underwent ARM during ALND between January 2010and July 2012 were included in this study. Twenty-five patients were clinically node-positiveand underwent ALND without sentinel lymph node biopsy (SLNB). Thirty-five patients wereclinically node-negative but sentinel node-positive on the SLND. The lymphatic pathway wasvisualized using fluorescence imaging with indocyanine green. ARM nodes in ALND field,whose status was diagnosed using FNAC, were removed and processed for histology. Weevaluated the correlation between the cytological findings of FNAC and the histologicalanalysis of excised ARM nodes. Results: The mean number of ARM nodes identified per patient was 1.6 +/-0.9 in both groups. In mostpatients without (88%) and with (79%) SLNB, the ARM nodes were located between theaxillary vein and the second intercostobrachial nerve. FNAC was performed for 45 ARMnodes, 10 of which could not be diagnosed. Six of the patients without SLNB (24%) andonewith SLNB (3%) had positive ARM nodes. Of these sevenpatients, four had >3 positiveARM nodes. There was no discordance between the cytological and histological diagnosis ofARM nodes status. Conclusions: Positive ARM nodes were observed in the patients not only with extensive nodal metastasisbut also in those with a few positive nodes. FNAC for ARM nodes was helpful in assessingARM nodes metastasis, which can be beneficial in sparing nodes essential for lymphaticdrainage, thereby potentially reducing the incidence of lymphedema. However, the success ofsampling rates needs to be improved.

via World Journal of Surgical Oncology