Axillary reverse mapping using a fluorescence imaging system in breast cancer

Background The axillary reverse mapping (ARM) procedure is based on the hypothesis that the lymphatic drainage from the upper arm is different from that of the breast. However, the oncologic safety of the procedure has not yet been determined. Methods: The ARM nodes were identified using a fluorescence imaging system. Axillary lymph node dissection (ALND) was performed in patients with clinically involved nodes, and the ARM nodes were removed separately during ALND. Sentinel lymph node (SLN) biopsy was performed in patients with clinically uninvolved nodes. If the SLN was positive, ALND was performed with removal of ARM nodes. Otherwise, the identified ARM nodes were preserved unless they were the same as the SLN. Results: ARM nodes were identified in 29 (85%) of 34 patients who underwent ALND, and 11 had tumor involvement. The ARM node was identified in 42 (43%) of 97 patients who underwent SLN biopsy, and it was the same as the SLN in 27 patients. However, in 15 patients with a positive SLN who subsequently underwent ALND, ARM nodes were tumor-free when they were not the same as the positive SLN. Conclusions: It may be feasible to spare ARM nodes during ALND in patients with positive SLN. J. Surg. Oncol. 2012;105:229-234. (C) 2011 Wiley Periodicals, Inc.