Axillary reverse mapping: Is it feasible in locally advanced breast cancer patients?
Identifieur interne : 001486 ( PubMed/Corpus ); précédent : 001485; suivant : 001487Axillary reverse mapping: Is it feasible in locally advanced breast cancer patients?
Auteurs : Rohan Khandelwal ; C U Poovamma ; Chauhan Shilpy ; M. Prema ; Pais AnthonySource :
- Breast disease [ 1558-1551 ] ; 2014.
English descriptors
- KwdEn :
- MESH :
- adverse effects : Lymph Node Excision.
- pathology : Breast Neoplasms, Lymph Nodes.
- prevention & control : Lymphedema.
- surgery : Breast Neoplasms.
- Adult, Axilla, Chemotherapy, Adjuvant, Female, Humans.
Abstract
Axillary dissection is associated with a high incidence of lymphedema, which has been brought down with the introduction of sentinel lymph node biopsy (SLNB) in patients with early breast cancer. However, sentinel lymph node biopsy is not widely accepted in patients of locally advanced breast cancer (LABC) [T3N1, Any T4, Any N2-3 with no distant metastasis] after neo-adjuvant chemotherapy (NACT) and these patients routinely undergo axillary lymph node clearance. Axillary reverse mapping (ARM) with blue dye has the potential to differentiate the arm lymphatics from the breast lymphatics and it can be used to decrease lymphedema in patients undergoing ALND by preserving these lymphatics. However, ARM in LABC patients is yet to be accepted as the standard of care.
DOI: 10.3233/BD-140371
PubMed: 24934169
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Axillary reverse mapping: Is it feasible in locally advanced breast cancer patients?</title><author><name sortKey="Khandelwal, Rohan" sort="Khandelwal, Rohan" uniqKey="Khandelwal R" first="Rohan" last="Khandelwal">Rohan Khandelwal</name><affiliation><nlm:affiliation>Department of Oncoplastic Breast Surgery, Shaw Mazumdar Cancer Center, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Poovamma, C U" sort="Poovamma, C U" uniqKey="Poovamma C" first="C U" last="Poovamma">C U Poovamma</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Shilpy, Chauhan" sort="Shilpy, Chauhan" uniqKey="Shilpy C" first="Chauhan" last="Shilpy">Chauhan Shilpy</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Prema, M" sort="Prema, M" uniqKey="Prema M" first="M" last="Prema">M. Prema</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Anthony, Pais" sort="Anthony, Pais" uniqKey="Anthony P" first="Pais" last="Anthony">Pais Anthony</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24934169</idno><idno type="pmid">24934169</idno><idno type="doi">10.3233/BD-140371</idno><idno type="wicri:Area/PubMed/Corpus">001486</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001486</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Axillary reverse mapping: Is it feasible in locally advanced breast cancer patients?</title><author><name sortKey="Khandelwal, Rohan" sort="Khandelwal, Rohan" uniqKey="Khandelwal R" first="Rohan" last="Khandelwal">Rohan Khandelwal</name><affiliation><nlm:affiliation>Department of Oncoplastic Breast Surgery, Shaw Mazumdar Cancer Center, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Poovamma, C U" sort="Poovamma, C U" uniqKey="Poovamma C" first="C U" last="Poovamma">C U Poovamma</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Shilpy, Chauhan" sort="Shilpy, Chauhan" uniqKey="Shilpy C" first="Chauhan" last="Shilpy">Chauhan Shilpy</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Prema, M" sort="Prema, M" uniqKey="Prema M" first="M" last="Prema">M. Prema</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author><author><name sortKey="Anthony, Pais" sort="Anthony, Pais" uniqKey="Anthony P" first="Pais" last="Anthony">Pais Anthony</name><affiliation><nlm:affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Breast disease</title><idno type="eISSN">1558-1551</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Axilla</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (surgery)</term><term>Chemotherapy, Adjuvant</term><term>Female</term><term>Humans</term><term>Lymph Node Excision (adverse effects)</term><term>Lymph Nodes (pathology)</term><term>Lymphedema (prevention & control)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Axilla</term><term>Chemotherapy, Adjuvant</term><term>Female</term><term>Humans</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Axillary dissection is associated with a high incidence of lymphedema, which has been brought down with the introduction of sentinel lymph node biopsy (SLNB) in patients with early breast cancer. However, sentinel lymph node biopsy is not widely accepted in patients of locally advanced breast cancer (LABC) [T3N1, Any T4, Any N2-3 with no distant metastasis] after neo-adjuvant chemotherapy (NACT) and these patients routinely undergo axillary lymph node clearance. Axillary reverse mapping (ARM) with blue dye has the potential to differentiate the arm lymphatics from the breast lymphatics and it can be used to decrease lymphedema in patients undergoing ALND by preserving these lymphatics. However, ARM in LABC patients is yet to be accepted as the standard of care.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24934169</PMID><DateCreated><Year>2014</Year><Month>08</Month><Day>06</Day></DateCreated><DateCompleted><Year>2015</Year><Month>05</Month><Day>11</Day></DateCompleted><DateRevised><Year>2014</Year><Month>08</Month><Day>06</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1558-1551</ISSN><JournalIssue CitedMedium="Internet"><Volume>34</Volume><Issue>4</Issue><PubDate><Year>2014</Year><Month>Jan</Month><Day>01</Day></PubDate></JournalIssue><Title>Breast disease</Title><ISOAbbreviation>Breast Dis</ISOAbbreviation></Journal><ArticleTitle>Axillary reverse mapping: Is it feasible in locally advanced breast cancer patients?</ArticleTitle><Pagination><MedlinePgn>151-5</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3233/BD-140371</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Axillary dissection is associated with a high incidence of lymphedema, which has been brought down with the introduction of sentinel lymph node biopsy (SLNB) in patients with early breast cancer. However, sentinel lymph node biopsy is not widely accepted in patients of locally advanced breast cancer (LABC) [T3N1, Any T4, Any N2-3 with no distant metastasis] after neo-adjuvant chemotherapy (NACT) and these patients routinely undergo axillary lymph node clearance. Axillary reverse mapping (ARM) with blue dye has the potential to differentiate the arm lymphatics from the breast lymphatics and it can be used to decrease lymphedema in patients undergoing ALND by preserving these lymphatics. However, ARM in LABC patients is yet to be accepted as the standard of care.</AbstractText><AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">51 patients of locally advanced breast carcinoma were included in the study from May 2011 to May 2012. All patients received neo-adjuvant chemotherapy followed by modified radical mastectomy. Axillary reverse mapping (ARM) was carried out using blue dye. 2 ml of methylene blue dye was injected intradermal, upper medial aspect of the ipsilateral arm. The number, size and site and distribution of lymph nodes identified were recorded and the nodes were labelled as ARM nodes and complete axillary dissection was carried out.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Blue nodes were identified in 45 (88.2%) out of the 51 patients. The average number of ARM nodes identified was 4.03 ± 0.28 [range 1-8]. In majority (77.8%) of the cases, nodes were located in the triangle formed by axillary vein above, below by the first intercostobrachial nerve and medially by the chest wall/serratus anterior. In patients with complete or partial response to NACT, ARM and breast axillary LN were negative in 63.3% patients whereas 36.6% had positive breast but negative ARM nodes. In this study we did not intend to preserve any ARM nodes but in 90% of these cases, at least one ARM node had to be removed or was injured during axillary clearance. ARM nodes could be identified in 15 (83.3%) out of the 18 patients with stable or progressive disease following ARM. 12 (80%) out of these 15 cases demonstrated positive ARM and breast LN whereas 3 (20%) patients had positive breast but negative ARM nodes. Skin tattooing (82.3%) was the most common complication observed in our study.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Identification rates of ARM nodes can be improved by injecting the blue dye in the upper medial aspect of the arm at the time of induction. Majority of the arm nodes lie between the axillary vein and the first intercostobrachial nerve. It is difficult to preserve the ARM nodes in patients of LABC, who have had good response to NACT and in patients of LABC with poor response to NACT, the incidence of metastasis in ARM nodes is quite high. Therefore, ARM is not a feasible option in patients with locally advanced breast cancer.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Khandelwal</LastName><ForeName>Rohan</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Oncoplastic Breast Surgery, Shaw Mazumdar Cancer Center, Narayana Hrudayalaya Health City, Bangalore, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Poovamma</LastName><ForeName>C U</ForeName><Initials>CU</Initials><AffiliationInfo><Affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shilpy</LastName><ForeName>Chauhan</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Prema</LastName><ForeName>M</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Anthony</LastName><ForeName>Pais</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Oncoplastic Breast Surgery Unit, Narayana Hrudayalaya Health City, Bangalore, India.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Breast Dis</MedlineTA><NlmUniqueID>8801277</NlmUniqueID><ISSNLinking>0888-6008</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001365" MajorTopicYN="N">Axilla</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001943" MajorTopicYN="N">Breast Neoplasms</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017024" MajorTopicYN="N">Chemotherapy, Adjuvant</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008197" MajorTopicYN="N">Lymph Node Excision</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008198" MajorTopicYN="N">Lymph Nodes</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008209" MajorTopicYN="N">Lymphedema</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Breast cancer</Keyword><Keyword MajorTopicYN="N">axillary reverse mapping</Keyword><Keyword MajorTopicYN="N">locally advanced</Keyword><Keyword MajorTopicYN="N">lymphedema</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>6</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>6</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2015</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24934169</ArticleId><ArticleId IdType="pii">530040L58VG33403</ArticleId><ArticleId IdType="doi">10.3233/BD-140371</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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