Selective axillary dissection after axillary reverse mapping to prevent breast-cancer-related lymphoedema

M. Gennaro, M. MacCauro, C. Sigari, P. Casalini, L. Bedodi, A. R. Conti, A. Caraceni, E. Bombardieri

Research output: Contribution to journalArticle

Abstract

Background It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL. Methods Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND). Results SAD was feasible in 75% of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients (p = 0.072). The median follow-up was 16 months (6-36), during which 9 patients developed a BCRL, 4 in group A (9%) and 5 in group B (33%); p = 0.035. None of the patients had nodal relapses during the follow-up. Conclusions Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.

Original languageEnglish
Pages (from-to)1341-1345
Number of pages5
JournalEuropean Journal of Surgical Oncology
Volume39
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Dissection
Lymph Node Excision
Radioisotopes
Lymphoscintigraphy
Learning Curve
Breast Cancer Lymphedema
Drainage
Recurrence
Incidence

Keywords

  • Axillary reverse mapping
  • Breast cancer
  • Prevention of lymphoedema
  • Selective axillary dissection

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Selective axillary dissection after axillary reverse mapping to prevent breast-cancer-related lymphoedema. / Gennaro, M.; MacCauro, M.; Sigari, C.; Casalini, P.; Bedodi, L.; Conti, A. R.; Caraceni, A.; Bombardieri, E.

In: European Journal of Surgical Oncology, Vol. 39, No. 12, 12.2013, p. 1341-1345.

Research output: Contribution to journalArticle

Gennaro, M. ; MacCauro, M. ; Sigari, C. ; Casalini, P. ; Bedodi, L. ; Conti, A. R. ; Caraceni, A. ; Bombardieri, E. / Selective axillary dissection after axillary reverse mapping to prevent breast-cancer-related lymphoedema. In: European Journal of Surgical Oncology. 2013 ; Vol. 39, No. 12. pp. 1341-1345.
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abstract = "Background It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL. Methods Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND). Results SAD was feasible in 75{\%} of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients (p = 0.072). The median follow-up was 16 months (6-36), during which 9 patients developed a BCRL, 4 in group A (9{\%}) and 5 in group B (33{\%}); p = 0.035. None of the patients had nodal relapses during the follow-up. Conclusions Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.",
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AU - Casalini, P.

AU - Bedodi, L.

AU - Conti, A. R.

AU - Caraceni, A.

AU - Bombardieri, E.

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N2 - Background It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL. Methods Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND). Results SAD was feasible in 75% of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients (p = 0.072). The median follow-up was 16 months (6-36), during which 9 patients developed a BCRL, 4 in group A (9%) and 5 in group B (33%); p = 0.035. None of the patients had nodal relapses during the follow-up. Conclusions Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.

AB - Background It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL. Methods Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND). Results SAD was feasible in 75% of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients (p = 0.072). The median follow-up was 16 months (6-36), during which 9 patients developed a BCRL, 4 in group A (9%) and 5 in group B (33%); p = 0.035. None of the patients had nodal relapses during the follow-up. Conclusions Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.

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