title: Feasibility study of axillary reverse mapping for patients with clinically node-negative breast cancer.
abstract: BACKGROUND
  The axillary reverse mapping (ARM) procedure was developed to identify and preserve arm lymphatic drainage during axillary lymph node dissection (ALND), thereby theoretically reducing the incidence of arm lymphedema. However, the oncological safety of this procedure has not yet been determined.
  
  
  METHODS
  Two hundred ninety-two patients with clinically negative nodes (cN0) underwent both sentinel lymph node (SLN) biopsy and ARM. SLN was identified by dye and gamma probe methods, and ARM nodes were identified using a fluorescence imaging system. If SLN was histologically positive, ALND was performed with removal of ARM nodes. Otherwise, identified ARM nodes were preserved unless they coincided with SLN. Postoperatively, SLN as well as ARM nodes were histologically examined with H&E staining.
  
  
  RESULTS
  SLN was identified in 286 of 292 patients, and ARM nodes were identified in 90 patients. In 54 patients with positive SLN, SLN was the same as the ARM node in 19 patients (the concordance type), whereas it was not an ARM node in the remaining 35 patients (the separate type). Non-SLN and ARM node was not involved in 51 of 54 patients with positive SLN, while it was involved in 3 patients of the concordance type.
  
  
  CONCLUSIONS
  When ARM nodes were involved in patients with cN0, these were most often the SLN-ARM nodes. Therefore, it may be concluded that ARM nodes that do not coincide with SLNs might be preserved during ALND in SLN-positive patients.
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan. Electronic address: nogumasa@kanazawa-med.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Morioka
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kurose
authors.affiliation: Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Minato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000473:pathology; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004396:Coloring Agents
keywords: Axillary reverse mapping; Breast cancer; Fluorescence imaging; Sentinel lymph node biopsy