title: Axillary reverse mapping (ARM) in clinically node positive breast cancer patients.
abstract: BACKGROUND
  Axillary reverse mapping (ARM) is a technique to map and preserve upper extremity lymphatic drainage during axillary lymph node dissection (ALND) in breast cancer patients. We prospectively evaluated the metastatic involvement of ARM-nodes in patients who underwent an ALND for clinically node positive disease following (neo)adjuvant chemotherapy (NAC) in comparison to patients in whom primary ALND was performed without NAC.
  
  
  METHODS
  Patients with clinically node positive invasive breast cancer, confirmed by fine needle aspiration cytology and scheduled for primary ALND were enrolled in the study. Patients were separated into two groups: one group treated with NAC (NAC+ group) and one group not treated with NAC (NAC- group). ARM was performed in all patients by injecting blue dye into the ipsilateral upper extremity. During ALND, ARM-nodes were first identified and removed separately, followed by a standard ALND.
  
  
  RESULTS
  91 patients were included in the NAC+ and 21 patients in the NAC- group. There was no difference in the ARM visualization rate between the two groups (86.8% for NAC+ group versus 90.5% for NAC- group, P = 0.647). In the NAC+ group 16.5% of the patients had metastatic involvement of the ARM-nodes versus 36.8% of the patients in the NAC- group (P = 0.048).
  
  
  CONCLUSIONS
  The risk of metastatic involvement of ARM-nodes in clinically node positive breast cancer patients is significantly lower in patients who have received NAC.
authors.affiliation: Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands. Electronic address: maarten_beek@hotmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Beek
authors.affiliation: Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Gobardhan
authors.affiliation: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Klompenhouwer
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Surgery, Maastricht University, Maastricht, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South, Eindhoven, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
authors.forename: E J T
authors.initials: EJ
authors.lastname: Luiten
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D042601:Lymphatic Vessels; D008209:Lymphedema / Q000517:prevention & control*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D034941:Upper Extremity
chemical_list: D004396:Coloring Agents
keywords: Axillary reverse mapping; Breast cancer; Lymphedema