title: A Prospective Study to Assess the Feasibility of Axillary Reverse Mapping and Evaluate Its Effect on Preventing Lymphedema in Breast Cancer Patients.
abstract: BACKGROUND
  The axillary reverse mapping (ARM) procedure can distinguish lymphatics draining the arm from those draining the breast. It has been proposed to preserve lymphatic drainage of the upper limbs and reduce the incidence of upper limb lymphedema during breast cancer surgery. The aim of our study was to assess the feasibility of ARM in modified radical mastectomy and to evaluate its effect on prevention of lymphedema.
  
  
  METHODS
  From January 2012 to March 2014, a prospective study was performed in 265 breast cancer patients who underwent modified radical mastectomy. Patients were divided into 2 groups, 127 patients (47.93%, control group) received a traditional axillary lymph node dissection (ALND), and 138 patients (52.07%, experimental group) received ARM preservation of the nodes and lymphatics during ALND. Radioactive tracer and methylene blue were used for ARM of the nodes and lymphatics. All of the identified ARM nodes were diagnosed using fine needle aspiration cytology for assessment of metastatic status. All resected axillary lymph nodes were conducted in a pathology examination to evaluate tumor metastasis. Data were collected on variations in identification of the ARM nodes and lymphatics, the metastasis of ARM nodes, and the occurrence of lymphedema.
  
  
  RESULTS
  In the experimental group, the ARM procedure was successfully conducted in 129 cases (93.48%). ARM nodes metastasis occurred in 11 patients (8.53%). The median follow-up time was 20 months, at the last evaluation there were 42 patients who developed upper limb lymphedema in the control group (33.07%), and in the experimental group the incidence of lymphedema was 5.93% (7/118; P < .001). None of the patients had nodal relapses during the follow-up time.
  
  
  CONCLUSIONS
  ARM appears to be a feasible technique with which to identify upper arm nodes and lymphatics during the modified radical mastectomy procedure. The incidence of lymphedema can be decreased in patients with use of the ARM procedure.
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yue
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Dayong
authors.initials: D
authors.lastname: Zhuang
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Luming
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Dong
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China. Electronic address: heqingqing@yeah.net.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis / Q000473:pathology; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000517:prevention & control*; D008751:Methylene Blue; D008875:Middle Aged; D011446:Prospective Studies; D011849:Radioactive Tracers; D011877:Radionuclide Imaging
chemical_list: D004396:Coloring Agents; D011849:Radioactive Tracers; D008751:Methylene Blue
keywords: Axillary lymph node dissection; Lymphoscintigraphy; Methylene blue; Surgery; Upper limb lymphedema