title: Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies.
abstract: BACKGROUND
  Axillary reverse mapping (ARM) is a novel technique for preserving the upper extremity lymphatic pathways during axillary lymph node surgery. However, there is no evidence of the usefulness of ARM for patients undergoing sentinel lymph node biopsy (SNB).
  
  
  METHODS
  Between August 2009 and July 2012, 372 patients who underwent the SNB procedure for breast cancer were enrolled in this study. Using the indocyanine green fluorescence technique and indigocarmine blue dye method, we studied the relationship between the upper extremity lymphatic flow and breast sentinel node (SN). Our aim of this study was the probability of postoperative lymphedema with respect to whether the upper extremity lymphatics corresponded to the breast SN.
  
  
  RESULTS
  Among the 327 patients who underwent the SNB procedure, the upper extremity lymphatics drainage into the breast SN in 76 (23.2%; corresponding group), and only 5 patients in this group developed lymphedema. In contrast, none of the patients in the noncorresponding group developed lymphedema.
  
  
  CONCLUSIONS
  ARM during SN biopsy can identify the group of patients who are at high risk for developing lymphedema. More risk-focused guidance should be used for these patients.
authors: Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan.
authors: Takashi
authors: T
authors: Sakurai
authors: Mariko
authors: M
authors: Endo
authors: Ken
authors: K
authors: Shimizu
authors: Nobunari
authors: N
authors: Yoshimizu
authors: Kenichirou
authors: K
authors: Nakajima
authors: Kaori
authors: K
authors: Nosaka
authors: Yuuko
authors: Y
authors: Dai
authors: Akiko
authors: A
authors: Iwao
authors: Yuki
authors: Y
authors: Jinnai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000209:etiology* / Q000517:prevention & control*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid; D007203:Indigo Carmine; D007208:Indocyanine Green
keywords: axillary reverse mapping; breast cancer; fluorescence image; lymphedema; sentinel lymphnode biopsy