Selective Axillary Lymph Node Dissection with Axillary Reverse Mapping. Is It Safe?

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Objective: Axillary Reverse Mapping (ARM) aims to preserve arm lymph nodes to prevent breast cancer-related lymphedema (BCRL). This study evaluates the oncological safety of ARM by assessing metastasis rates while preserving arm lymph nodes. Material and Methods: Twenty-five breast cancer patients undergoing Axillary Lymph Node Dissection (ALND) with ARM were included. Data collected encompassed diagnosis, age, gender, menopausal status, tumor diameter, total number of excised axillary lymph nodes, Axillary Metastatic Lymph Nodes (AMLN), axillary stained lymph nodes, axillary metastatic and stained lymph nodes, tumor grade, estrogen receptor (ER) status, progesterone receptor status, cErb-B2 status, TNM stage, and KI-67 level. Results: The mean age was 58.28 years. Five patients (20%) were premenopausal, and 20 (80%) were postmenopausal. All patients had positive axillary findings confirmed by clinical examination or core needle biopsy prior to surgery. Histopathological diagnosis revealed invasive ductal carcinoma in all cases. The mean tumor diameter was 19.70 mm. The average number of lymph nodes removed during ALND was 21.64, with a mean of 5.28 involved nodes. Conclusion: A statistically significant relationship was observed with tumor stage, N stage, AMLN, and cErbB2 level (p=0.017, p=0.011, p<0.001, p=0.017, respectively). Pearson correlation analysis indicated a positive correlation for tumor stage, N stage, and AMLN (p=0.015, p=0.011, p=0.015, respectively). Metastasis in arm lymph nodes was detected in two patients with N3 disease. Implementing the ARM technique in patients undergoing ALND, except for those where the Z0011 study recommends absolute ALND, may reduce BCRL incidence while ensuring oncological safety.

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