title: Extensive nodal disease may impair axillary reverse mapping in patients with breast cancer.
abstract: OBJECTIVE
  The aim of axillary reverse mapping (ARM) is to preserve arm lymphatics in patients with breast cancer who underwent surgical axillary staging.
  
  
  METHODS
  From June 2007 to December 2008, 49 patients who required axillary dissection (AD) underwent ARM. One milliliter of patent blue dye was injected in the ipsilateral arm, and all blue nodes identified during AD were sent separately for pathologic examination. Main variables associated with the detection rates of blue lymphatics, the pathologic status of blue and nonblue nodes, and the complications of the procedure were analyzed. Results Identification rates of blue lymphatics and blue nodes were 73.5% and 55.1%, respectively. Blue node identification was influenced by the time elapsed between injection of blue dye and surgery (P = .002) but not by the learning curve of the procedure. Although the blue node was clear of metastases in 24 of 27 patients, three patients with extensive nodal metastatic involvement (ie, pN2a and pN3a) showed breast cancer metastatic cells in the blue nodes as well. The only adverse effect of the procedure was skin tattooing at the injection site, which disappeared within 4 months in almost 80% of the procedures.
  
  
  CONCLUSIONS
  In patients with clinically negative axillary nodes, additional study is warranted to assess whether ARM may be used to spare the lymphatics from the arm. In the presence of extensive nodal disease, this technique may identify metastatic blue nodes, which demonstrates that there is not reliable separation of arm and breast lymphatic pathways.
authors.affiliation: Gynecological Oncology, University of Turin, Institute for Cancer Research and Treatment of Candiolo, Turin, Italy. rponzone@mauriziano.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ponzone
authors.forename: Nicoletta Tomasi
authors.initials: NT
authors.lastname: Cont
authors.forename: Furio
authors.initials: F
authors.lastname: Maggiorotto
authors.forename: Elisa
authors.initials: E
authors.lastname: Cassina
authors.forename: Paola
authors.initials: P
authors.lastname: Mininanni
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.forename: Piero
authors.initials: P
authors.lastname: Sismondi
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000556:secondary*; D015331:Cohort Studies; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery; D008209:Lymphedema / Q000517:prevention & control; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents