title: Prospective study evaluating oncological safety of axillary reverse mapping.
abstract: BACKGROUND
  Axillary reverse mapping (ARM) is a new technique developed with the aim of reducing lymphedema rates by preserving lymphatic drainage of the upper limbs during sentinel lymph node biopsy and axillary lymph node dissection (ALND). However, it is unclear whether preservation of these lymph nodes affects oncological risk. The present study evaluated the presence of metastases in ARM nodes.
  
  
  METHODS
  A total of 45 patients underwent ARM during ALND. Blue dye was used for ARM nodes localization. All axillary lymph nodes, including ARM nodes, were removed and sent separately for pathological evaluation of metastases.
  
  
  RESULTS
  ARM identification was achieved in 40/45 patients (88.9 %). The average number of removed ARM nodes was 1.9. ARM nodes metastasis occurred in 10 of 40 patients (25 %). Patients with an axilla extensively affected by cancer had an elevated risk of metastasis to the arm's lymph nodes (p < 0.001).
  
  
  CONCLUSIONS
  The rate of arm lymph nodes compromised by metastases calls into question the viability of the ARM technique. Larger studies may point to particular patient profiles for which ARM can be safely use.
authors.affiliation: Department of Gynecology and Obstetrics, Clinical Hospital of Federal University of Paraná, Curitiba, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schunemann
authors.forename: Maíra Teixeira
authors.initials: MT
authors.lastname: Dória
authors.forename: Janiceli Blanca Carlotto Hablich
authors.initials: JB
authors.lastname: Silvestre
authors.forename: Plínio
authors.initials: P
authors.lastname: Gasperin
authors.forename: Teresa Cristina Santos
authors.initials: TC
authors.lastname: Cavalcanti
authors.forename: Vinicius Milani
authors.initials: VM
authors.lastname: Budel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000473:pathology / Q000601:surgery; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000556:secondary* / Q000601:surgery; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology* / Q000601:surgery; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*