J Breast Cancer.  2009 Sep;12(3):179-185. 10.4048/jbc.2009.12.3.179.

Preservation of Lymphatic Drainage of Arm during Axillary Procedure in Breast Cancer Patients

• Choi JE
• Jeon YS
• Kang SH
• Lee SJ

• KMID: 2242009
• DOI: http://doi.org/10.4048/jbc.2009.12.3.179

Abstract

PURPOSE
The aim of this study was to confirm the feasibility of the technique, the so called "axillary reverse mapping (ARM)", and to test the hypothesis that the arm lymphatics are never involved by the metastatic process of breast cancer.
METHODS
We reviewed the prospectively maintained database of 129 patients who underwent an operation for breast cancer. Blue dye was injected in the upper inner arm to identify the draining lymphatics or lymph nodes from the arm. During the axillary procedure, we found the "blue" ARM node and the "hot" sentinel lymph node (SLN). The histological results of the ARM nodes were compared with those of the other nodes harvested in SLN biopsy (SLNB) or axillary lymph node dissection (ALND).
RESULTS
The ARM nodes were identified in 78.3% (101/129) of the patients. The ARM nodes were identified in 71.6% (58/81) of the patients with SLNB and in 88.4% (38/43) of the patients with SLNB followed by ALND and in all cases with ALND. In 19 of the 96 SLNB cases, the ARM nodes were hot or the SLNs were blue (concordant case), yielding an 18.9% concordant rate between the ARM node and the SLN. Among these 19 concordant cases, 7 ARM nodes contained metastasis (36.8%). But in the 77 non-concordant cases, only one ARM node was positive for metastasis (1.3%) in a heavily metastasized axilla. The ARM nodes were identified in all five ALND cases, and one ARM node was positive for metastasis.
CONCLUSION
It is thought that lymphatic drainage from the arm can share common lymphatic channels in the axilla with lymphatic flow from breast, and these concordant ARM nodes may be involved by the metastatic process of breast cancer. However in the non-concordant cases, ARM nodes will be free from the danger of axillary dissection.

Keyword

Arm; Breast neoplasms; Sentinel lymph node biopsy

MeSH Terms

Arm
Axilla
Biopsy
Breast
Breast Neoplasms
Drainage
Humans
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Nitriles
Pyrethrins
Sentinel Lymph Node Biopsy
Nitriles
Pyrethrins

Figure

• 

  Figure 1 Identification of a blue ARM node (arrow) in relation with the lymphatic drainage (arrowheads) from arm in the axilla.

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