Blue Dye Injection in the Arm in Order to Conserve the Lymphatic Drainage of the Arm in Breast Cancer Patients Requiring an Axillary Dissection

Abstract

Identifying the LAD with blue dye injection in the arm is possible. A subsequent study can now begin to determine if this procedure is safe for patients and able to prevent lymphedema of the arm.

“Reverse axillary mapping in early stage breast cancer Is it oncologically safe? A feasibity study

“…The mean RAM node yield was 1.83 (range 1-3 nodes ) same as in previous studies [4,19]. Only one patient of 11 with RAM node identified , had metastatic disease in the RAM node (9.09%) which is lesser when compared to rate described in literature (11-25%) [10,19].…”

“…In our study, using methylene blue dye injection, at the start of surgery, blue lymphatics were identified in72.2 % while blue lymph nodes could be identified in 61.1%.The pattern of distribution of arm lymphatics in axilla varies with respect to axillary vein . Bonetti et al described 5 common variations in the distribution of arm lymphatics in the axilla [6], with most of the lymphatics and lymph node being found within the region formed by inferior margin of axillary vein and the second intercostobrachial nerve and thoraco dorsal pedicle [4,5,11,17].In our study, 69.2% of the identified arm lymphatics was within one cm inferior to axillary vein, lateral to thoraco dorsal pedicle.RAM lymphatics were successfully identified in 10 of 13 patients with negative axilla, in 2/2 patients with pN1 disease but only in 1/3 patients with pN3 disease. This may be postulated to be secondary to lymphatic obstruction by extensive disease in axilla as described in literature [9,18] .…”

“…The mean time between injection and commencement of axillary dissection was 41.27 minutes for our patients, which was little longer than that described in literature [4,11]. The mean nodal yield from the axillary dissection was 17.9 (range 11-32 nodes).…”

“…A number of techniques have been described in literature for the identification of arm lymphatics in the axilla, using blue dye [4,6,8], radio isotope [9] and fluorescence [17]. Rate of Identification of arm lymphatics varies from 33.3% in initial studies to as high as 91% with use of radio isotopes, [8,9].…”

“…Reverse axillary mapping (RAM) technique, is a recent development, aimed at identifying the arm lymphatics in axilla at the time of axillary surgery for carcinoma breast. Various techniques have been described for the same -using blue dye ,radioisotope or fluorescence imaging [2][3][4][5]. Although arm and breast lymphatics have been postulated to have differential drainage crossover has been documented in 2-18% [1,[5][6][7] with pathologically proven involvement of nodes draining the arm by metastatic carcinoma from breast in 0-43% [5,[7][8][9][10][11].…”