Prospective Study of Axillary Reverse Mapping Using Indocyanine Green in Breast Cancer

Background: Axillary Reverse Mapping (ARM) is an emerging technique aimed at preserving upper limb lymphatic drainage during axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) in breast cancer surgery.The use of Indocyanine green (ICG), a near infrared fluorescent dye, has enhanced the visualization and identification of lymphatic pathways, potentially reducing the risk of lymphedema.Methods: A prospective study using ICG for ARM, injecting into web space of ipsilateral upper limb intraoperatively.Near infrared florescence imaging was used intraoperatively to trace the lymphatic drainage pathways from the arm.Arm lymphatics and nodes were identified and FNAC and excision of node in the template of ALND done to assess the oncological safety.Results: The application of ICG based ARM facilitated 96% of visualization of ARM lymphatics and 91% visualization of ARM nodes.The malignant positivity of ARM Node is 6% and 9% by FNAC and HPE respectively.Conclusion: ICG guided ARM is a feasible and safe adjunct to axillary surgery in breast cancer.By enabling real time visualization of arm lymphatics, it allows surgeon to selectively preserve critical structures, minimizing the risk of lymphedema while maintaining oncological safety.Further investigation through larger studies with extended follow-up is needed to integrate this technique into routine practice.