Axillary reverse mapping: mapping and preserving arm lymphatics may be important in preventing lymphedema during sentinel lymph node biopsy.

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Axillary reverse mapping: mapping and preserving arm lymphatics may be
important in preventing lymphedema during sentinel lymph node biopsy.

J Am Coll Surg. 2008 May

Boneti C, Korourian S, Bland K, Cox K, Adkins LL, Henry-Tillman RS,
Klimberg VS.
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.

Elsevier - Journal of the American College of Surgeons

http://www.journalacs.org/article/S1072-7515(07)01983-7/abstract

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Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com