AI Article Synopsis
- The study explores the effectiveness of axillary reverse mapping (ARM) using near-infrared (NIR) fluorescence imaging during axillary lymph node dissection (ALND) in breast cancer patients.
- A total of 119 patients participated, with 94.5% successfully having ARM nodes identified; most ARM nodes were localized in a specific region (zone D).
- The findings suggest that while ARM is reliable for identifying lymph nodes at risk, only the level of mitosis in diagnostic biopsies was significantly linked to the presence of cancer in the ARM nodes.
Article Abstract
Background: Axillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement.
Methods: The study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts.
Results: 94.5% of patients had ARM nodes identified (95%CI = [88.4-98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis.
Conclusions: ARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement.
Clinical Trial Registration: NCT02994225.
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| http://dx.doi.org/10.1016/j.ejso.2022.07.004 | DOI Listing |
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