Clinical Utility Of Axillary Reverse Mapping In Breast Cancer Patients Undergoing Axillary Lymph Node Dissection

Objective:To assess the feasibility of axillary reverse mapping(ARM)in breast cancer patients with axillary lymph node dissection(ALND)through examing the status of draining lymph nodes of the ipsilateral arm.Methods:A total of 192 breast cancer patients undergoing ALND were recruited in this study from March 2015 to October 2016.All of the patients were diagnosed with invasive breast cancer and a clinically positive axilla.Carbon nanoparticles suspension was injected in the ipsilateral upper arm before surgery for ARM procedure.Axillary lymph nodes were divided into five quadrants(partA?B?C?D and E)according to their locations to the axillary vein and thoracodorsal vessel.Finally,all the lymph nodes were dissected and sent for pathological examination.Results:Black dyed lymph nodes were identified in 169 out of 192 patients(88%)with an average of 4 ARM nodes removed.The longger time interval between tracer injection and the start of surgery,the more ARM nodes identified(P<0.001).Metastatic involvement of the ARM-nodes was found in 33 of 169 patients.There was a significant difference between the metastatic involvement of ARM nodes and other nodes(p<0,001).The more tumor infiltration of the axillary,the more lymph nodes dyed by carbon nanoparticles(P=0.0005)and the more metastatic involvement of the ARM-nodes(P=0.0058).Among patients with a short interval(2-3hours)between tracer injection and the start of surgery,ARM nodes nocated between the anterior edge of the fatissimus dorsi muscle and the thoracodorsal vessel were negative.Conclusion:Carbon nanoparticles suspension is a feasible visualisation technique carrying out the ARM procedure.ARM nodes identified by carbon nanoparticles suspension between the anterior edge of the latissimus dorsi muscle and the thoracodorsal vessel may be preserved in early breast cancer patients with a appropriate injection time(2-3hours)prior to surgery.