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

Jung Eun Choi; Young San Jeon; Su Hwan Kang; Soo Jung Lee

doi:10.4048/jbc.2009.12.3.179

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Choi, Jeon, Kang, and Lee: Preservation of Lymphatic Drainage of Arm during Axillary Procedure in Breast Cancer Patients

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2009; 12(3): 179-185.

Published online: 28 September 2009

DOI: https://doi.org/10.4048/jbc.2009.12.3.179

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

Jung Eun Choi, Young San Jeon, Su Hwan Kang, Soo Jung Lee

Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Corresponding author (crystallee@medical.yu.ac.kr)

Received 27 February 2009 Accepted 13 August 2009

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.

Keywords: Arm, Breast neoplasms, Sentinel lymph node biopsy

Figures and Tables

Figure 1

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

Table 1

Identification rate of ARM node

ARM=arm reverse mapping; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

Table 2

Concordance^* rate of ARM node with sentinel lymph node

ARM=arm reverse mapping; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

^*Concordant case is defined as "blue" ARM node was hot or "hot" sentinel node was blue.

Table 3

Clinicopathologic features of the patients with concordant^* lymph node

ALN=axillary lymph node; ARM=arm reverse mapping; LIQ=low inner quadrant; LOQ=low outer quadrant; UIQ=upper inner quadrant; UOQ=upper outer quadrant.

^*Concordant case is defined as "blue" ARM node was hot or "hot" sentinel node was blue.

Table 4

Metastatic rate of ARM node

ARM=arm reverse mapping; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

^*Concordant case is defined as "blue" ARM node was hot or "hot" sentinel node was blue.

Table 5

Clinical characteristics of the ARM node metastatic patients

ALN=axillary lymph node; ARM=arm reverse mapping; sALND=sentinel lymph node biopsy followed by axillary lymph node dissection; ALND=axillary lymph node dissection.

^*Concordant case is defined as "blue" ARM node was hot or "hot" sentinel node was blue.

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