Oncological safety of selective axillary dissection after axillary reverse mapping in node-positive breast cancer |
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| Affiliation: | 1. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy;2. Department of Clinical Epidemiology and Trials Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy;3. Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy;4. Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy;5. Radiation Therapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy;1. Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France;2. Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy;3. Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France;4. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;5. University of Lorraine, CNRS, CRAN, F-54000, Nancy, France;1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;2. Institute of Innovative Cancer Research, Asan Medical Center, Seoul, 05505, Republic of Korea;3. Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;4. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;1. Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Cardiothoracic Surgery, Postbus 9101, 6500, HB Nijmegen, the Netherlands;2. Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA Leiden, the Netherlands;3. Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands;4. Amsterdam University Medical Center, Department of Surgery, Postbus 7057, 1008 MB Amsterdam, the Netherlands;5. Amsterdam University Medical Center, Department of Cardiothoracic Surgery, Postbus 7057, 1008, MB Amsterdam, the Netherlands |
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| Abstract: | IntroductionAlthough the need for axillary lymph node dissection (AD) is decreasing in breast cancer patients, it remains necessary in some cases. Axillary reverse mapping (ARM) enables the detection of upper extremity lymphatic drainage that may be spared during selective axillary dissection (SAD) so as to reduce the risk of lymphedema.The ability of the ARM-SAD procedure to reduce the incidence of lymphedema is being tested in an ongoing randomized trial. Crossover between arm drainage and breast drainage is well documented in the axilla, however, and whether the procedure is oncologically safe remains controversial. We aim to assess the axillary failure rate when a few nodes draining the upper arm are being spared by the ARM-SAD.MethodsWe report oncological outcomes, and axillary failure in particular, in the first 100 consecutive axillary node-positive patients treated with ARM-SAD as part of a pilot study and a randomized trial.ResultsA median of 18 (IQR 14–22) axillary nodes were excised per patient. During the follow-up (median 51 months, IQR 34–91), 11 patients experienced a treatment failure, but only one - treated with neoadjuvant chemotherapy - developed overt axillary disease as a first (and isolated) event. The crude rate of axillary failure was 1.36% (95% CI: 0.19–9.63) with an estimated 5-year crude cumulative incidence of 1.85% (95% CI: 0–5.47%).ConclusionsThe axillary failure rate was low in our patients and did not exceed rates reported in the literature after standard AD, thus indicating that the ARM-SAD procedure is oncologically safe. |
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| Keywords: | Axillary reverse mapping Axillary dissection Oncological safety Breast-cancer-related lymphedema |
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