Breast Surgical Unit, Breast Cancer Center, Department of Gynecology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
J Surg Oncol. 2012 Jul 1;106(1):89-93. doi: 10.1002/jso.23048. Epub 2012 Jan 18.
The axillary reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We conducted this study to assess the feasibility of the technique and the outcomes of patients with neoadjuvant chemotherapy (NAC).
From July 2009 to May 2010, a prospective study was performed in 36 patients with breast cancer undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC previously to the ARM and 7 patients had an ALND and ARM performed as first treatment for positive axillary nodes.
The identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node (SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15, two patients (13%) had a concordance between the blue and the hot node. Blue nodes were positive in 4 (13%) of the 30 patients.
The ARM technique is feasible in patients undergoing NAC. Patients with extensive nodal involvement have increased risk of having positive blue nodes. More studies are needed to assess the subgroup of patients with positive axilla that may have the blue node spared without compromising the oncological treatment.
腋窝反向绘图（ARM）技术已被提出用于预防手臂淋巴水肿。我们进行这项研究是为了评估该技术的可行性以及接受新辅助化疗（NAC）的患者的结果。
从 2009 年 7 月至 2010 年 5 月，对 36 例接受 ALND 的乳腺癌患者进行了前瞻性研究。在同侧手臂中注射 3cm(3)的专利蓝以进行 ARM 技术。在 36 例患者中，29 例在 ARM 之前接受了 NAC，7 例患者因阳性腋窝淋巴结而行 ALND 和 ARM 作为一线治疗。
蓝色淋巴结的识别率为 83.3%（30 例）。在 NAC 组的 29 例患者中有 15 例（42%）进行了前哨淋巴结（SLN）检测。在这 15 例中，有 2 例（13%）蓝色和热点淋巴结之间存在一致性。30 例患者中有 4 例（13%）蓝色淋巴结呈阳性。
ARM 技术在接受 NAC 的患者中是可行的。广泛淋巴结受累的患者有更高的风险出现阳性蓝色淋巴结。需要更多的研究来评估可能保留蓝色淋巴结而不影响肿瘤治疗的阳性腋窝亚组患者。
