Implementation and evaluation of axillary reverse mapping technique in breast cancer patients using patent blue dye

IntroductionBreast cancer is the most common malignancy among Egyptian women. Following axillary lymph node dissection, arm lymphedema can develop in 7-77% of cases. To detect and preserve upper-limb lymphatics and lymph nodes after axillary surgery, the axillary reverse mapping (ARM) technique was developed. This procedure may help avoid arm lymphedema.Aim of workTo establish the ARM-node involvement of cancer cells and study their location to assess the effectiveness of ARM using patent blue dye.MethodologyAt Kasr Alainy University Hospital, this prospective randomized controlled study was carried out. There were 42 breast cancer patients in total, including 21 each in the study group and the control group. Following dye injection, stained ARM lymph nodes and lymphatics were preserved in the study group during axillary lymph node (ALN) dissection if grossly negative and removed if grossly positive, whereas individuals in the control group had the standard technique. After 1 month, all subjects underwent a second evaluation, during which the arm circumference was measured and recorded at a point 10 cm near the medial epicondyle.ResultsIn the study group, in 18 patients (85.7%) their lymph nodes were stained. Six patients had suspiciously colored lymph nodes that were surgically removed, but no metastatic disease was apparent in the rest of the group. Early upper-limb lymphedema was not detected in the study group (0%), with 9.5% in the control group.ConclusionArm lymphedema can be avoided by doing ARM while performing ALN dissection. Future research should be conducted on more patients and for a longer length of time, according to the findings of this study.

Automated summary

The ARM technique was developed to detect and preserve upper-limb lymphatics and lymph nodes after axillary surgery, in order to avoid arm lymphedema. This study aimed to establish the involvement of cancer cells in ARM lymph nodes and evaluate the effectiveness of ARM using patent blue dye.