Evaluation of the Axillary Reverse Mapping Technique in Preventing Breast Cancer-Related Post Operative Lymphedema, Ain Shams University Initial Experience

Abstract Background Management of breast cancer patients with clinically positive nodes is a field of research and axillary lymph nodes dissection is still an acceptable option for them. However it affects the patient quality of life in the form of breast cancer related lymphedema. Axillary reversed mapping technique is used to spare the arm lymph nodes during Axillary surgery aiming to reduce the rate of breast cancer related lymphedema. Objective To study the feasibility of using patent blue dye to perform axillary reverse mapping procedure in breast cancer patients with positive axillary lymph nodes scheduled for axillary lymph node dissection. Patients and Methods A prospective study including 20 patient with clinically positive axillary lymph nodes planed by MDT Committee at Ain Shams university hospital to perform axillary lymph nodes dissection. Results Identification rate of lymphatics and lymph nodes was 75% and 80% respectively and 60% of the stained LNS were seen below the axillary vein and lateral to the thoracodorsal bundle. Correlation between identification rate of the lymphatics and the lymph nodes with regard to N-staging and Neoadjuvant therapy wasn't statistically significant. BMI and number of lymph nodes removed were a confounding variables related to lymphedema. Conclusion Axillary Reverse mapping procedure using patent blue dye is simple idea to preserve arm lymph nodes and so, decreases the incidence of lymphedema, however there are a lot of variables related to lymphedema development which needs to be investigated well on larger group of patients and further multicentrs studies with long term follow up. The operative technique is quite challenging and need longer learning curve with well orientation to the axillary anatomy.