Boneti C, Korourian S, Bland K, Cox K, Adkins LL, Henry-Tillman RS, Klimberg VS, et al.
Journal of the American College of Surgeons. Date of publication 2008 May 1;volume 206(5):1038-42; discussion 1042-4.
1. J Am Coll Surg. 2008 May;206(5):1038-42; discussion 1042-4. doi:
10.1016/j.jamcollsurg.2007.12.022. Epub 2008 Mar 3.
Axillary reverse mapping: mapping and preserving arm lymphatics may be important
in preventing lymphedema during sentinel lymph node biopsy.
Boneti C(1), Korourian S, Bland K, Cox K, Adkins LL, Henry-Tillman RS, Klimberg
VS.
Author information:
(1)Division of Breast Surgical Oncology, Department of Surgery, University of
Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, Little
Rock, AR, USA.
BACKGROUND: Several recent reports have shown a lymphedema rate of about 7% with
sentinel lymph node biopsy (SLNB) only. We hypothesized that this higher than
expected rate of lymphedema may be secondary to disruption of arm lymphatics
during an SLNB procedure.
STUDY DESIGN: This IRB-approved study, from May 2006 to June 2007, involved
patients undergoing SLNB with or without axillary lymph node dissection. After
sentinel lymph node (SLN) localization with subareolar technetium was assured, 2
to 5 mL of dermal blue dye was injected in the upper inner arm for localization
of lymphatics draining the arm (axillary reverse mapping, ARM). The SLNB was then
performed through an incision in the axilla. Data were collected on
identification rates of hot versus blue nodes, variations in ARM lymphatic
drainage that might impact SLNB, crossover between the hot and the blue
lymphatics, and final pathologic nodal diagnosis.
RESULTS: Median age was 57.6+/-12.5 years. Lymphatics draining the arm were near
or in the SLN field in 42.7% (56 of 131) of the patients, placing the patient at
risk for disruption if not identified and preserved during an SLNB or axillary
lymph node dissection. ARM demonstrated that arm lymphatics do not cross over
with the SLN drainage of the breast 96.1% of the time and that none of the ARM
lymph nodes removed were positive, even when the SLN was (5 of 12). Seven (5.5%)
blue ARM lymphatics were juxtaposed to the hot SLNBs.
CONCLUSIONS: Disruption of the blue ARM node because of proximity to the hot SLN
may explain the surprisingly high rate of lymphedema seen after SLNB. Identifying
and preserving the ARM blue nodes may translate into a lower incidence of
lymphedema with SLNB and axillary lymph node dissection.
DOI: 10.1016/j.jamcollsurg.2007.12.022
PMID: 18471751 [Indexed for MEDLINE]
