Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies

BACKGROUND: Axillary reverse mapping (ARM) is a novel technique for preserving the upper extremity lymphatic pathways during axillary lymph node surgery. However, there is no evidence of the usefulness of ARM for patients undergoing sentinel lymph node biopsy (SNB). METHODS: Between August 2009 and July 2012, 372 patients who underwent the SNB procedure for breast cancer were enrolled in this study. Using the indocyanine green fluorescence technique and indigocarmine blue dye method, we studied the relationship between the upper extremity lymphatic flow and breast sentinel node (SN). Our aim of this study was the probability of postoperative lymphedema with respect to whether the upper extremity lymphatics corresponded to the breast SN. RESULTS: Among the 327 patients who underwent the SNB procedure, the upper extremity lymphatics drainage into the breast SN in 76 (23.2%; corresponding group), and only 5 patients in this group developed lymphedema. In contrast, none of the patients in the noncorresponding group developed lymphedema. CONCLUSIONS: ARM during SN biopsy can identify the group of patients who are at high risk for developing lymphedema. More risk-focused guidance should be used for these patients. J. Surg. Oncol. 2014 109:612–615.