Axillary reverse mapping with indocyanine green or isosulfan blue demonstrate similar crossover rates to radiotracer identified sentinel nodes

Foster, Deshka S.; Choy, Nicole; Porter, C. R.; Ahmed, Sheikh Z.; Wapnir, Irene

doi:10.1002/jso.24859

Cited by 21 publications

(17 citation statements)

References 26 publications

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“…In the present study, the crossover rate between SLN and ARM nodes was 28%, whereas crossover was seen only in 3.8% of the SLN biopsy and 5.6% of ALND in a study by Tummel, et al [4]. The crossover rates are much higher in several studies using uorescence than in those using dye [3,4,20,21,23]. Although these studies did not agree with the hypothesis that the lymphatic drainage of the arm and the breast are separate [1,2], crossover of SLN-ARM nodes is the main reason for ARM node involvement in patients with positive SLN [9,11,12,24].…”

Section: Discussioncontrasting

confidence: 51%

“…Although ARM is generally performed using blue dye, uorescent dye can also be used as an alternative to blue dye for ARM procedure. Several centers have reported using uorescent imaging technique for ARM [3,20,21,22,23]. The uorescent imaging technique is highly sensitive for identifying ARM nodes [3].…”

Section: Discussionmentioning

confidence: 99%

“…The uorescent imaging technique is highly sensitive for identifying ARM nodes [3]. The identi cation rates of ARM nodes are higher in the uorescent method than in the dye method, and more ARM nodes are identi ed using the uorescent method than using the dye method [20,21,22]. Nevertheless, the identi cation rates of ARM nodes are very different between the ALND eld and the SLN eld, suggesting that the majority of lymphatics draining the upper extremity may be located deeper than the SLNs [3,9,21].…”

Section: Discussionmentioning

confidence: 99%

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Oncological Safety of Axillary Reverse Mapping in Patients With Clinically Node-Negative Breast Cancer

Noguchi

Inokuchi

Yokoi-Noguchi

et al. 2021

Preprint

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Background Axillary reverse mapping (ARM) was developed to preserve the lymphatic drainage from the upper arm during sentinel lymph node (SLN) biopsy or axillary lymph node dissection (ALND). However, the oncological safety of ARM has been controversial. Methods Patients with clinically negative nodes (cN0) underwent SLN biopsy and ARM. SLNs were identified using blue dye and radioisotope, and ARM nodes were traced using the fluorescent method. Patients with positive SLN underwent the standard ALND. After surgery, they were followed up for more than three years. Results A total of 507 patients with cN0 breast cancer were enrolled between May 2009 and November 2017. SLNs were identified in 499 (98%) of 507 patients, and ARM nodes were identified in 159 (31%) patients in the SLN field. The crossover rate of SLN-ARM nodes was 28%. Among 95 patients with positive SLNs, 70 patients underwent conventional ALND. ARM nodes were identified in 65 (93%) of those patients in the ALND field. The mean number of removed ARM nodes was 7.2 (range 0–25) in patients who underwent the standard ALND. Although ARM nodes were involved in 18 of 65 patients, the involved ARM nodes were the same SLNs identified in 14 (78%) patients. Since SLN-ARM nodes should be removed, ARM nodes were involved only in 4 (5.7 %) patients after SLN biopsy. Conclusions ARM nodes were not infrequently involved in patients with positive SLNs, but they were most often SLNs. Therefore, conservative ALND with ARM is oncologically acceptable in patients with positive SLN.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oncological Safety of Axillary Reverse Mapping in Patients With Clinically Node-Negative Breast Cancer

Noguchi

Inokuchi

Yokoi-Noguchi

et al. 2021

Preprint

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“…ICG fluorescence imaging has been used in other procedures for the mapping of the lymphatic system drainage, 23–25 and we found it to be more sensitive than MB (87.8% vs 52.5%) during ARM, largely due to its optical properties. Upon excitation, ICG emits a highly penetrative infrared fluorescence (peak, ∼820 nm), with a higher signal‐to‐noise ratio than visible light, facilitating lymphatic visualization in deeper tissue and providing clearer definition from surrounding elements.…”

Section: Discussionmentioning

confidence: 82%

“…ICG is therefore a promising replacement of MB. However, the dual usage of ICG and MB makes it possible to map the lymphatic system of the breast and upper arm simultaneously 24,25 …”

Section: Discussionmentioning

confidence: 99%

Comparison of indocyanine green and methylene blue use for axillary reverse mapping during axillary lymph node dissection

Wang

Zeng

et al. 2020

MedComm

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Axillary reverse mapping (ARM) is a technique to identify arm lymphatic drainage during axillary lymph node dissection (ALND). This study compared the feasibility of ARM using indocyanine green (ICG) or methylene blue (MB), and accessed the oncologic safety of the procedure. Overall, 158 patients qualified for ALND were enrolled. The characteristics of ARM‐identified nodes were recorded with ICG (n = 78) or MB (n = 80) visualization. Fine‐needle aspiration cytology (FNAC) of the nodes were performed and validated by histologic analysis. The nodal identification rate in the ICG group significantly surpassed that of the MB group (87.2% vs 52.5%, P < .05) with fewer complications. Note that 10.9% of the patients had metastatic involvement of the ARM‐identified nodes. Also 80% of the positive nodes were found in areas B and D, while the ARM‐identified nodes mainly located in area A. All the 51 nodes diagnosed as negative of malignancy by FNAC were free of metastasis. Nodal metastasis was significantly correlated with extensive nodel involvement, advanced disease, and the characteristics of identified nodes. In conclusion, ICG appears superior to MB for ARM nodes identification. FNAC, together with the features of primary tumors and ARM nodes, can delineate which nodes could be preserved during ALND.

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Sentinel Lymph Node Biopsy and Axillary Staging for Breast Cancer

Erdahl

Scott‐Conner

2022

Chassin's Operative Strategy in General Surgery

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Axillary reverse mapping with indocyanine green or isosulfan blue demonstrate similar crossover rates to radiotracer identified sentinel nodes

Abstract: Nearly one-third of patients showed crossover between breast and arm draining nodes, which provides insight as to why some patients develop lymphedema symptoms after SLN biopsy. ICG and ISB identify similar numbers of SLNs. As such ICG could substitute for ISB in ARM procedures.

Cited by 21 publications

References 26 publications

Oncological Safety of Axillary Reverse Mapping in Patients With Clinically Node-Negative Breast Cancer

Oncological Safety of Axillary Reverse Mapping in Patients With Clinically Node-Negative Breast Cancer

Comparison of indocyanine green and methylene blue use for axillary reverse mapping during axillary lymph node dissection

Sentinel Lymph Node Biopsy and Axillary Staging for Breast Cancer

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