Annals of Surgical Oncology

, Volume 20, Issue 10, pp 3303–3307

Axillary Reverse Mapping: A Prospective Study in Women with Clinically Node Negative and Node Positive Breast Cancer

  • Carol Connor
  • Marilee McGinness
  • Joshua Mammen
  • Lori Ranallo
  • Stephanie LaFaver
  • Jennifer Klemp
  • Fang Fan
  • Jonathan Mahnken
Breast Oncology

Abstract

Background

The primary aim of axillary reverse mapping (ARM) is to prevent lymphedema by preserving arm versus breast axillary lymphatics. Concerns regarding feasibility and oncologic safety have limited the adoption of the technique. This prospective study was undertaken to investigate ARM in clinically node negative and node positive breast cancer patients.

Methods

A total of 184 patients underwent 212 ARM procedures: 155 sentinel lymph node biopsies (SLNB) without axillary lymph node dissection (ALND) (group 1) and 57 ALNDs with/without SLNB (group 2). ARM lymphatics were not preserved if they were a SLN, directly entered a SLN, or were within ALND boundaries during ALND.

Results

SLN with radioisotope alone was successful in 92 % of procedures (181 of 197). ARM identification was 47 % (73 of 155) in group 1. Criteria were met in 30 % (47 of 155) for preservation, and 25 % (38 of 155) were preserved. Of those who met preservation criteria, 81 % (38 of 47) were preserved. In group 2, ARM identification was 72 % (41 of 57); 7 met criteria for preservation and were preserved. Of the ARM nodes, 10 % (22 of 212) were SLNs (crossover). ARM nodes contained metastatic disease in one crossover and two nonsentinel ARM nodes in clinically node positive patients with N2/N3 disease.

Conclusions

ARM is a feasible technique for identification and preservation of axillary arm lymphatics with an acceptable incidence of SLN crossover. A larger sample size is needed to determine if ARM can reduce the incidence of lymphedema in patients undergoing SLNB alone and to confirm the absence of ARM metastases in clinically node negative patients undergoing ALND.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Carol Connor
    • 1
  • Marilee McGinness
    • 1
  • Joshua Mammen
    • 1
  • Lori Ranallo
    • 2
  • Stephanie LaFaver
    • 2
  • Jennifer Klemp
    • 3
  • Fang Fan
    • 4
  • Jonathan Mahnken
    • 5
  1. 1.Department of SurgeryUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Department of NursingUniversity of Kansas Medical CenterKansas CityUSA
  3. 3.Division of Oncology, Department of MedicineUniversity of Kansas Medical CenterKansas CityUSA
  4. 4.Department of PathologyUniversity of Kansas Medical CenterKansas CityUSA
  5. 5.Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityUSA

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