Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection

Nos, Claude; Clough, K.; Bonnier, Pascal; Lasry, S.; Bouëdec, G. Le; Flipo, B.; Classe, Jean‐Marc; Missana, M.-C.; Doridot, Virginie; Giard, S.; Charitansky, H.; Charles-Nelson, Anaïs; Bats, Anne-Sophie; Ngô, Charlotte

doi:10.1016/j.ejso.2016.07.138

Cited by 29 publications

(18 citation statements)

References 31 publications

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“…4 E). Moreover, the pooled results of five studies [ 7 , 26 , 28 , 32 , 34 ] did not show a significant correlation between NAC and ARM nodes (OR = 1.20, 95% CI 0.74–1.94, I 2 = 49.4%, P = 0.095) ( Fig. 4 F).…”

Section: Resultsmentioning

confidence: 90%

“…Twenty-nine articles published between January 2007 and January 2020 describing studies of 4954 patients were included in this meta-analysis [ 1 , 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. These included four randomized controlled trials [ 1 , [20] , [21] , [22] ] and 25 prospective non-randomized studies [ 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [23] , [24] , [25] ].…”

Section: Resultsmentioning

confidence: 99%

“…(2016) [ 2 ] Prospective Japan SLNB with or without ALND(292); ALND with SLNB (48) Blue dye + fluorescence SLND: 31% (90/292) ALND: 86%(36/42) 27%(77/286) 21%(19/90) SLNB: 1%(2/244) 45 months Moderate quality 06/2012–12/2014 Nos et al. (2016) [ 34 ] Prospective France ALND alone (172) Radioisotope ALND: 100%(172/172) NA 31%(54/172) SLNB + ALND: 27% 34 months Moderate quality 12/2009–12/2012 Kumar et al. (2017) [ 35 ] Prospective India ALND alone (20) Blue dye ALND: 75%(15/20) NA 13%(2/15) NA NA Moderate quality 05/2014–07/2015 Tummel et al.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies investigated the SLN + axillary status ARM metastatic rate [ 9 , 11 , 24 , 26 , 34 ]. Regardless of the presence of additional metastases in other lymph nodes extracted during ALND, our pooled ARM node metastasis rate within the SLN + patient group was 22% (95% CI 13%–33%, I 2 = 22.8%, P = 0.269) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Our present analysis revealed an overall SLN-ARM node crossover rate of 12%; most included studies found similar rates of metastasis in the ARM nodes and SLNs, indicating that crossover is a significant contributing factor to metastases in the lymph nodes of the upper limb. As a proof of concept, data based on the analysis of the 27 studies [ 1 , 2 , [6] , [7] , [8] , 11 , [14] , [15] , [16] , [17] , [18] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ] revealed that the pooled metastatic rate of ARM nodes was 13%. As such, ARM nodes are indeed less likely to contain metastases than other axillary lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Wijaya¹,

Peng²,

et al. 2020

The Breast

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Background The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was developed to prevent breast-cancer related lymphedema (BCRL) remains controversial. Methods A comprehensive search of Medline Ovid, Pubmed, Web of Science and the Cochrane CENTRAL databases was conducted from the inception till January 2020. The key word including “breast cancer”, “axillary reverse mapping”, and “lymphedema”. Stata 15.1 software was used for the meta-analysis. Results As a result, twenty-nine related studies involving 4954 patients met our inclusion criteria. The pooled overall estimate lymphedema incidence was 7% (95% CI 4%–11%, I 2 = 90.35%, P < 0.05), with SLNB showed a relatively lower pooled incidence of lymphedema (2%, 95% CI 1%–3%), I 2 = 26.06%, P = 0.23) than that of ALND (14%, 95% CI 5%–26%, I 2 = 93.28%, P < 0.05) or SLNB and ALND combined (11%, 95% CI 1%–30%). The ARM preservation during ALND procedure could significantly reduce upper extremity lymphedema in contrast with ARM resection (OR = 0.27, 95% CI 0.20–0.36, I 2 = 31%, P = 0.161). Intriguingly, the result favored ALND-ARM over standard-ALND in preventing lymphedema occurrence (OR = 0.21, 95% CI 0.14–0.31, I 2 = 43%, P = 0.153). The risk of metastases in the ARM-nodes was not significantly lower in the patients who had received neoadjuvant chemotherapy, as compared to those without neoadjuvant treatment (OR = 1.20, 95% CI 0.74–1.94, I 2 = 49.4%, P = 0.095). Conclusions ARM was found to significantly reduce the incidence of BCRL. The selection of patients for this procedure should be based on their axillary nodal status. Preoperative neoadjuvant chemotherapy has no significant impact on the ARM lymph node metastasis rate.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Wijaya¹,

Peng²,

et al. 2020

The Breast

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Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

Coroneos

Woodward

Wong

et al. 2020

Journal of Surgical Oncology

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Background This study characterizes the physiological drainage of the normal upper extremity using single‐photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (ARM). Methods A consecutive series of patients assessed with SPECT/CT lymphoscintigraphy ARM of the upper extremity were included. Anatomical localization of the axillary sentinel lymph nodes (SLN) was completed in normal axillae in relation to consistent anatomic landmarks. Retrospective case note analysis was performed to collect patient demographic data. Results A total of 169 patients underwent SPECT/CT lymphoscintigraphy, and imaging of 182 normal axillae was obtained. All patients (100%) had an axillary SLN identified: 19% had a single contrast‐enhanced SLN in the axilla and the remainder had multiple. The SLN(s) of the upper extremity was located in the upper outer quadrant (UOQ) of the axilla in 97% of cases (177 axillae). When the SLN(s) was found in the UOQ of the axilla, second‐tier lymph nodes were found predominantly in the upper inner quadrant (50% of cases). Conclusions The upper extremity SLN(s) is located in a constant region of the axilla. This study provides the most complete investigation to date and results can be directly applied clinically to ARM techniques and adjuvant radiation planning.

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Outcomes and technical modifications of vascularized lymph node transplantation from the lateral thoracic region for treatment of lymphedema

Coroneos

Asaad

Wong

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: This study evaluates clinical outcomes of vascularized lymph node transplantation (VLNT) from the lateral thoracic region and technical modifications. Methods: Consecutive patients that underwent lateral thoracic VLNT to treat extremity lymphedema were included. Demographic and treatment data were recorded, and outcomes data including limb volume, LDex score, and Lymphedema Life Impact Scale (LLIS), QuickDASH, and LEFS questionnaires, were collected prospectively. Consecutive patients that underwent single-photon emission computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (RLM) were analyzed to characterize the physiological drainage of the normal upper extremity.Results: A consecutive series of 32 flaps were included. At 24 months postoperatively mean reduction in limb volume excess was 47.2% (±11.6; p = 0.0085), LDex score was 63.1% (±8.5; p < 0.001), and LLIS score was 65.1% (±7.4; p < 0.001).Preoperatively 14/31 patients (45.2%) reported cellulitis, and postoperatively there were no episodes at up to 24 months (p < 0.001). No patient developed donor extremity lymphedema at mean 18.6 (±8.3) months follow-up. SPECT/CT-RLM of 182 normal axillae demonstrated that the sentinel lymph node(s) of the upper extremity was consistently anatomically located in the upper outer quadrant of the axilla (97%).Conclusions: VLNT from the lateral thoracic region is effective and versatile for the treatment of lymphedema with a low donor site complication rate.

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Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection

Cited by 29 publications

References 31 publications

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

Outcomes and technical modifications of vascularized lymph node transplantation from the lateral thoracic region for treatment of lymphedema

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