title: Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer.
abstract: BACKGROUND
  The axillary reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We conducted this study to assess the feasibility of the technique and the outcomes of patients with neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  From July 2009 to May 2010, a prospective study was performed in 36 patients with breast cancer undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC previously to the ARM and 7 patients had an ALND and ARM performed as first treatment for positive axillary nodes.
  
  
  RESULTS
  The identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node (SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15, two patients (13%) had a concordance between the blue and the hot node. Blue nodes were positive in 4 (13%) of the 30 patients.
  
  
  CONCLUSIONS
  The ARM technique is feasible in patients undergoing NAC. Patients with extensive nodal involvement have increased risk of having positive blue nodes. More studies are needed to assess the subgroup of patients with positive axilla that may have the blue node spared without compromising the oncological treatment.
authors.affiliation: Breast Surgical Unit, Breast Cancer Center, Department of Gynecology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. irubio@vhebron.net
authors.forename: Isabel T
authors.initials: IT
authors.lastname: Rubio
authors.forename: Isaac
authors.initials: I
authors.lastname: Cebrecos
authors.forename: Vicente
authors.initials: V
authors.lastname: Peg
authors.forename: Antonio
authors.initials: A
authors.lastname: Esgueva
authors.forename: Cesar
authors.initials: C
authors.lastname: Mendoza
authors.forename: Tomas
authors.initials: T
authors.lastname: Cortadellas
authors.forename: Octavi
authors.initials: O
authors.lastname: Cordoba
authors.forename: Martin
authors.initials: M
authors.lastname: Espinosa-Bravo
authors.forename: Jordi
authors.initials: J
authors.lastname: Xercavins
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods