Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Japan.
J Surg Oncol. 2010 Mar 1;101(3):217-21. doi: 10.1002/jso.21473.
The ARM technique was proposed to prevent arm lymphedema after ALND and/or SLN biopsy. However, several problems remain to be resolved in the practical application of this technique.
The fluorescent ARM nodes and/or lymphatics were identified using a fluorescence imaging system with subdermal injection of indocyanine green into the upper limb. ALND was performed in patients with clinically involved nodes, and the ARM nodes were separately removed during ALND. SLN biopsy was performed in patients with clinically uninvolved nodes. If SLN was positive, ALND was performed with removal of ARM nodes. Otherwise, identified ARM nodes were preserved unless they were the same as SLN.
ARM nodes and/or lymphatics were identified in 7 (88%) of 8 patients who underwent ALND, whereas they were identified in 9 (75%) of 12 patients who underwent SLN biopsy alone. ARM nodes were involved with tumors in 3 (43%) of the former patients, and SLN was the same as the ARM node in 2 (14%) of 14 patients who underwent SLN biopsy.
Fluorescence imaging was sensitive for identification of ARM nodes and/or lymphatics. However, further studies are needed before efforts to preserve these nodes can be safely implemented.
ARM 技术旨在预防 ALND 和/或 SLN 活检后的手臂淋巴水肿。然而，在该技术的实际应用中仍存在一些问题需要解决。
荧光 ARM 节点和/或淋巴管通过在上肢皮内注射吲哚菁绿，使用荧光成像系统进行识别。对于临床有淋巴结受累的患者进行 ALND，并在 ALND 期间单独切除 ARM 淋巴结。对于临床无淋巴结受累的患者进行 SLN 活检。如果 SLN 阳性，则进行 ALND 切除 ARM 淋巴结。否则，除非与 SLN 相同，否则保留已识别的 ARM 淋巴结。
在接受 ALND 的 8 例患者中，有 7 例（88%）识别出了 ARM 淋巴结和/或淋巴管，而在单独接受 SLN 活检的 12 例患者中，有 9 例（75%）识别出了 ARM 淋巴结和/或淋巴管。在前一组患者中，有 3 例（43%）的 ARM 淋巴结与肿瘤有关，在接受 SLN 活检的 14 例患者中，有 2 例（14%）的 SLN 与 ARM 淋巴结相同。
荧光成像对识别 ARM 淋巴结和/或淋巴管具有敏感性。然而，在能够安全实施保存这些淋巴结的努力之前，还需要进一步的研究。
