Objectives: ARM technique aims at preventing lymphedema in patients undergoing axillary lymph node dissection (ALND) by identifying and sparing nodes and lymphatic pathway draining upper limb. Aim of our study was to evaluate ARM method and metastatic status of ARM related nodes. Methods: Fifty breast cancer patients scheduled for ALND were enrolled in a prospective study on ARM radiotracer-based procedure. All patients underwent subcutaneous injection of Tc99m-colloid in both tumour ipsilateral and contralateral hand as control, mean activity per hand 97.7MBq (73-130) fractioned in all web spaces. Scintigraphic images were acquired on arms and axillae early (5-20') and late (2-3h) after injection in order to visualize the most active nodes (ARMn). ALND was performed using a gamma-probe for radioguided surgery in order to identify ARMn. ARMn histologic examination was performed separately from other ALND nodes. Results: Scintigraphy allowed detecting ARMn in both axillae in all patients: no change in ARMn visualization from early to late acquisitions was observed. Surgeons identified and removed 58 ARMn in 50 patients: 1 in 45 patients, 2 in 2, 3 in 3. Histology demonstrated the absence of metastatic involvement in ARMn in 48 patients (96%); metastasis was found in 2 cases (4%) of aggressive and extended disease, respectively (G3 pT1 pN2 ductal and pT2 pN3 lobular infiltrating carcinoma). Differently, ALND resulted positive for axillary metastatic involvement in 29/50 patients (58%) and negative in 21 (42%). Conclusions: In our study ARMn resulted free from disease in 96% of patients, being consistent with data published in Literature. ARM technique provided surgeons with a precise mapping of nodes that drain arm and could be preserved, differentiating them from breast draining ones to be removed in ALND: this could represent an important contribution in breast surgery potentially preventing lymphedema. A study to evaluate potential benefits of ARMn preservation is starting in our Institution.
Axillary reverse mapping (ARM) in breast cancer and evaluation of ARM related nodes metastatic status
CARCOFORO, Paolo;CITTANTI, Corrado;
2014
Abstract
Objectives: ARM technique aims at preventing lymphedema in patients undergoing axillary lymph node dissection (ALND) by identifying and sparing nodes and lymphatic pathway draining upper limb. Aim of our study was to evaluate ARM method and metastatic status of ARM related nodes. Methods: Fifty breast cancer patients scheduled for ALND were enrolled in a prospective study on ARM radiotracer-based procedure. All patients underwent subcutaneous injection of Tc99m-colloid in both tumour ipsilateral and contralateral hand as control, mean activity per hand 97.7MBq (73-130) fractioned in all web spaces. Scintigraphic images were acquired on arms and axillae early (5-20') and late (2-3h) after injection in order to visualize the most active nodes (ARMn). ALND was performed using a gamma-probe for radioguided surgery in order to identify ARMn. ARMn histologic examination was performed separately from other ALND nodes. Results: Scintigraphy allowed detecting ARMn in both axillae in all patients: no change in ARMn visualization from early to late acquisitions was observed. Surgeons identified and removed 58 ARMn in 50 patients: 1 in 45 patients, 2 in 2, 3 in 3. Histology demonstrated the absence of metastatic involvement in ARMn in 48 patients (96%); metastasis was found in 2 cases (4%) of aggressive and extended disease, respectively (G3 pT1 pN2 ductal and pT2 pN3 lobular infiltrating carcinoma). Differently, ALND resulted positive for axillary metastatic involvement in 29/50 patients (58%) and negative in 21 (42%). Conclusions: In our study ARMn resulted free from disease in 96% of patients, being consistent with data published in Literature. ARM technique provided surgeons with a precise mapping of nodes that drain arm and could be preserved, differentiating them from breast draining ones to be removed in ALND: this could represent an important contribution in breast surgery potentially preventing lymphedema. A study to evaluate potential benefits of ARMn preservation is starting in our Institution.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
