Tabagua, T. T., Levchenko, V. E., Mortada, V. V., Pesotsky Roman. S., R. S., Amirov, N., Emelyanov, A. S., Mortada, M. M., Krzhivitsky, P. I., Semiglazov, V. F., & Krivorotko, P. V. (2024). The The Role of Axillary Reverse Mapping during Sentinel Lymph Node Biopsy in Breast Cancer Patients. Voprosy Onkologii, 70(3), 499–505. https://doi.org/10.37469/0507-3758-2024-70-3-499-505

Abstract

Introduction. The incidence of lymphedema after axillary lymphadenectomy varies widely, ranging from 14.1 % to 33.4 %, with the highest rates seen in patients receiving adjuvant radiation therapy. The routine use of sentinel lymph node biopsy (SLNB) instead of lymphatic axillary dissection (LAD) resulted in a lower incidence of lymphedema, ranging from 3.5 % to 11 %. Therefore, even when we perform an SLNB procedure, we cannot always offset the risk of complications. This is because the lymph nodes responsible for lymph drainage in the upper limb may be among the removed sentinel lymph nodes.

Aim. To evaluate the relationship between sentinel lymph nodes and lymph nodes responsible for the lymph drainage from the upper limb in BC patients when performing SLNB by radioactive isotope (RI) method and with visualization of the lymph collector of the upper limb using indocyanine green (ICG), an axillary reverse mapping (ARM) technique.

Materials and Methods. The retrospective analysis was carried out on the basis of FSBI N.N. Petrov NMRC of Oncology. Thirty-five patients diagnosed with breast cancer during the surgical stage of treatment, including SLNB and the method of ARM using ICG was applied to visualise lymph nodes and vessels responsible for lymph drainage of upper limb tissues.

Results. In 6 (17.14 %) cases, the sentinel lymph node turned out to be the lymph node responsible for the lymphatic collector of the upper limb. Standard pathomorphology showed tumour cells in only 1 in 6 cases. In the remaining 29 cases (82.86 %) it was possible to preserve the lymphatic collector (lymph nodes and lymphatic vessels) from the tissues of the upper limb.

Conclusion. The analysis carried out showed that the marking of lymphatic vessels in the upper limb allows the differentiation of the zones responsible for lymphatic drainage, which in turn determines a selective approach to lymph node removal. Also, if the lymph node responsible for draining lymph from the upper limb is removed, preventive measures can be taken to prevent lymphostasis.

https://doi.org/10.37469/0507-3758-2024-70-3-499-505

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