pISSN 1738-6756   eISSN 2092-9900
Open Access, Peer-reviewed
    J Breast Cancer. 2009 Sep;12(3):179-185. Korean.
    Published online Sep 28, 2009.
    https://doi.org/10.4048/jbc.2009.12.3.179
    Copyright © 2009 Korean Breast Cancer Society
    Original Article

    Preservation of Lymphatic Drainage of Arm during Axillary Procedure in Breast Cancer Patients

    Jung Eun Choi, Young San Jeon, Su Hwan Kang and Soo Jung Lee
      • Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.
    • Corresponding author (Email: crystallee@medical.yu.ac.kr )
    Received February 27, 2009; Accepted August 13, 2009.

    Abstract

    Purpose

    The aim of this study was to confirm the feasibility of the technique, the so called "axillary reverse mapping (ARM)", and to test the hypothesis that the arm lymphatics are never involved by the metastatic process of breast cancer.

    Methods

    We reviewed the prospectively maintained database of 129 patients who underwent an operation for breast cancer. Blue dye was injected in the upper inner arm to identify the draining lymphatics or lymph nodes from the arm. During the axillary procedure, we found the "blue" ARM node and the "hot" sentinel lymph node (SLN). The histological results of the ARM nodes were compared with those of the other nodes harvested in SLN biopsy (SLNB) or axillary lymph node dissection (ALND).

    Results

    The ARM nodes were identified in 78.3% (101/129) of the patients. The ARM nodes were identified in 71.6% (58/81) of the patients with SLNB and in 88.4% (38/43) of the patients with SLNB followed by ALND and in all cases with ALND. In 19 of the 96 SLNB cases, the ARM nodes were hot or the SLNs were blue (concordant case), yielding an 18.9% concordant rate between the ARM node and the SLN. Among these 19 concordant cases, 7 ARM nodes contained metastasis (36.8%). But in the 77 non-concordant cases, only one ARM node was positive for metastasis (1.3%) in a heavily metastasized axilla. The ARM nodes were identified in all five ALND cases, and one ARM node was positive for metastasis.

    Conclusion

    It is thought that lymphatic drainage from the arm can share common lymphatic channels in the axilla with lymphatic flow from breast, and these concordant ARM nodes may be involved by the metastatic process of breast cancer. However in the non-concordant cases, ARM nodes will be free from the danger of axillary dissection.

    Keywords
    Arm; Breast neoplasms; Sentinel lymph node biopsy

    Figures

    Figure 1
    Identification of a blue ARM node (arrow) in relation with the lymphatic drainage (arrowheads) from arm in the axilla.

    Tables

    Table 1
    Identification rate of ARM node

    Table 2
    Concordance* rate of ARM node with sentinel lymph node

    Table 3
    Clinicopathologic features of the patients with concordant* lymph node

    Table 4
    Metastatic rate of ARM node

    Table 5
    Clinical characteristics of the ARM node metastatic patients

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    MeSH Terms
    Arm
    Axilla
    Biopsy
    Breast
    Breast Neoplasms
    Drainage
    Humans
    Lymph Node Excision
    Lymph Nodes
    Neoplasm Metastasis
    Nitriles
    Pyrethrins
    Sentinel Lymph Node Biopsy
    Metrics
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