title: Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection.
abstract: BACKGROUND
  Two thirds of node-positive breast cancer patients have limited pN1 disease and could benefit from a less extensive axillary lymph node dissection (ALND).
  
  
  METHODS
  172 breast cancers patients requiring an ALND were prospectively enrolled in the Sentibras Protocol of Axillary Reverse Mapping (ARM). Radioisotope was injected in the ipsilateral hand the day before surgery. ALND was standard. Removed lymph nodes were classified into non radioactive nodes and radioactive nodes (ARM nodes). Among ARM nodes, nodes located in the upper outer part of the axilla, above the second intercostal brachial nerve and lateral to the lateral thoracic vein were identified as "zone D ARM nodes". The main objective was: feasibility of identification of the zone D ARM nodes. Secondary objectives were: metastatic involvement and lymphedema rate.
  
  
  RESULTS
  100% of patients had ARM nodes identified. The "zone D ARM nodes" were identified in 92% of cases. The rate of metastatic nodes was 60% in the all cohort, 31% in ARM nodes and 9% in zone D ARM nodes. Among those, metastatic rate was 6% in patients undergoing ALND for a positive sentinel node biopsy, 6% in case of primary ALND versus 14% after neo-adjuvant chemotherapy (p < 0.05). After 34 months of median follow up, 27% of interviewed patients had a lymphedema.
  
  
  CONCLUSIONS
  The ARM technique reliably identifies the "zone D ARM nodes". These nodes can also easily be identified using knowledge of axillary anatomy. In selected patients, a selective ALND sparing the zone D ARM nodes could be performed.
authors: Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015 Paris, France; L'institut du Sein, Paris Breast Center, 7 Avenue Bugeaud, 75016 Paris, France. Electronic address: claude.nos@sfr.fr.
authors: C
authors: C
authors: Nos
authors: L'institut du Sein, Paris Breast Center, 7 Avenue Bugeaud, 75016 Paris, France.
authors: K B
authors: KB
authors: Clough
authors: Hôpital Privé Beauregard, 23 rue des Linots, 13012 Marseille, France.
authors: P
authors: P
authors: Bonnier
authors: Department of Surgery, Institut Curie (Site Saint Cloud), 35 Rue Dailly, 92210 St Cloud, France.
authors: S
authors: S
authors: Lasry
authors: Department of Surgery, Centre Jean Perrin, Place Henri Dunant, 63000 Clermont Ferrand, France.
authors: G
authors: G
authors: Le Bouedec
authors: Department of Breast Surgery, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06000 Nice, France.
authors: B
authors: B
authors: Flipo
authors: Department of Surgery, Institut de Cancerologie de l'Ouest (René Gauducheau), Site Hospitalier Nord, Boulevard Jacques Monod, 44805 Saint-Herblain, France.
authors: J-M
authors: JM
authors: Classe
authors: Department of Plastic Surgery, Centre Hospitalier Princesse Grace, Avenue Pasteur, 98000 Monaco, Monaco.
authors: M-C
authors: MC
authors: Missana
authors: Department of Breast Surgery, Centre République, 99 Avenue de la République, 63000 Clermont Ferrand, France.
authors: V
authors: V
authors: Doridot
authors: Department of Breast Surgery, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59020 Lille, France.
authors: S
authors: S
authors: Giard
authors: Department of Surgery, Institut Claudius Regaud, 20-24 Rue du pont Saint-Pierre, 31000 Toulouse, France.
authors: H
authors: H
authors: Charitansky
authors: Unité d'Épidémiologie et de Recherche Clinique, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015 Paris, France.
authors: A
authors: A
authors: Charles-Nelson
authors: Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015 Paris, France; Faculté de Medicine, Université Paris Descartes, Paris, France.
authors: A-S
authors: AS
authors: Bats
authors: Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015 Paris, France; Faculté de Medicine, Université Paris Descartes, Paris, France.
authors: C
authors: C
authors: Ngo
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla / Q000601:surgery; D000072656:Breast Cancer Lymphedema / Q000453:epidemiology; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy
chemical_list: D000970:Antineoplastic Agents
keywords: Axillary dissection; Axillary reverse mapping; Breast carcinoma; Lymphedema; Multicentric study; Sentinel lymph node dissection