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A phase I study to assess the feasibility and oncologic safety of axillary reverse mapping in breast cancer patients
Author(s) -
Bedrosian Isabelle,
Babiera Gildy V.,
Mittendorf Elizabeth A.,
Kuerer Henry M.,
Pantoja Laura,
Hunt Kelly K.,
Krishnamurthy Savitri,
MericBernstam Funda
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.25096
Subject(s) - medicine , breast cancer , cancer , oncology , surgery
BACKGROUND: Axillary reverse mapping (ARM) is a novel technique to preserve upper extremity lymphatics that may reduce the incidence of lymphedema after axillary lymph node dissection. Early reports have suggested that ARM lymph nodes do not contain metastatic disease from breast cancer; however, these studies were conducted in early stage patients with low likelihood of lymph node metastasis. This study reported a phase 1 trial conducted in patients with cytologically documented axillary metastasis undergoing axillary lymph node dissection to determine the feasibility and oncologic safety of ARM. METHODS: Thirty patients, 23 (77%) of whom received preoperative therapy (chemotherapy in 22 patients and hormonal therapy in 1 patient), were enrolled. Blue dye was injected in the upper inner ipsilateral arm. The presence of blue lymphatics was noted, and blue lymph nodes were sent separately for pathologic evaluation. RESULTS: The average time between blue dye injection and axillary exposure was 35 minutes (range, 15‐60 minutes). Blue lymphatics were identified in 21 patients (70%) and blue lymph nodes in 15 patients (50%). The median number of ARM lymph nodes was 1 (range, 0‐3 lymph nodes) and the median number of axillary lymph nodes was 26 (range, 6‐47 lymph nodes). Axillary metastases were noted in 60% (18 of 30) of patients. Of 11 patients who had axillary metastasis and at least 1 ARM lymph node identified, 2 (18%) had metastasis to the ARM lymph node. CONCLUSIONS: ARM appears to be a feasible technique with which to identify upper arm lymphatics during axillary surgery. However, the high prevalence of disease involving ARM lymph nodes in this small cohort suggested that preservation of these lymphatics is not oncologically safe in women with documented axillary lymph node metastasis from breast cancer. Cancer 2010. © 2010 American Cancer Society.