The influence of axillary reverse mapping related factors on lymphedema in breast cancer patients.
OBJECTIVE
Upper extremity lymphedema (LE) is a harmful breast cancer complication. It has been reported that patient- or treatment-related risk factors of LE. Axillary reverse mapping (ARM) has been performed to prevent LE during axillary lymph node dissection (ALND) by visualizing the upper extremity lymphatics. We investigated whether ARM related factors included novel predictive risk factors of LE.


METHODS
ARM revealed fluorescent axillary nodes (ARM nodes) in 76 patients by fluorescence imaging. Only ARM nodes within the ALND field were removed. Twenty-four (32%) patients developed LE (LE+) and 52 did not (LE-) during a median 24-month post-surgical follow-up period. We retrospectively evaluated the clinical features and ARM factors of LE+ and LE-.


RESULTS
The positive ARM node rate among LE+ was 42%, significantly greater frequency than that among LE- (13%: p ≤ 0.05). Cranial collectors (lymphatic ducts along or above the axillary vein) were significantly more frequent in LE- (44%) than in LE+ (21%: p ≤ 0.05). Multivariate analysis revealed postoperative radiation and positive ARM nodes to be positive risk factors and cranial collectors to be a negative risk factor of LE.


CONCLUSIONS
ARM factors could predict the incidence of LE post-axillary surgeries in breast cancer patients.
Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. Electronic address: bfaqt406@cwo.zaq.ne.jp.
K
K
Ikeda
Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
Y
Y
Ogawa
Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
C
C
Kajino
Department of Gastroenterological Surgery, Osaka City General Hospital, Japan.
S
S
Deguchi
Department of Gastroenterological Surgery, Osaka City General Hospital, Japan.
S
S
Kurihara
Department of Gastroenterological Surgery, Osaka City General Hospital, Japan.
T
T
Tashima
Department of Gastroenterological Surgery, Osaka City General Hospital, Japan.
W
W
Goto
Department of Gastroenterological Surgery, Osaka City General Hospital, Japan.
Y
Y
Nishiguchi
Department of Medical Oncology, Osaka City General Hospital, Japan.
S
S
Tokunaga
Department of Pathology, Osaka City General Hospital, Japan.
H
H
Fukushima
Department of Pathology, Osaka City General Hospital, Japan.
T
T
Inoue
D000368:Aged; D001365:Axilla / Q000601:surgery; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005453:Fluorescence; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008209:Lymphedema / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D034941:Upper Extremity
Axillary reverse mapping; Breast cancer; Fluorescence imaging; Lymphedema; Predictive factor