Application of Axillary Reverse Lymphatic Mapping in Surgery of Early Stage Breast Cancer

Objective To investigate the infl uencing factors for the success rate of ARM by blue dying on patients with axillary negative invasive breast cancer detected by imaging examination. The rate of upper limb lymphedema and related risk factors were compared and analyzed after ALND with preserved ARM lymph node and normal ALND. Methods Fifty patients with invasive breast cancer and preoperative axillary negative tested by imaging examination were involved. 2 ml of methylene blue dye was injected into ipsilateral upper extremity subcutaneous and intramuscular during the operation. The developing lymphatic ducts and lymph nodes were observed and preserved. The incidences of postoperative upper extremity lymphedema after ALND with preserved ARM lymph nodes and ALND after the failure of ARM were compared. Some factors, including age and body mass index????were tested by normality test, t test and multivariate logistic regression analysis. Results Thirty-four cases(68%) of ARM(total 50 cases) were successful, while 16 cases(34%) of ARM failed. BMI value and incidence of upper extremity lymphedema in ARM were lower insucceeded patients than that in failed ones (all P=0.01). But the age factor was not associated with ARM succeeded or not (P=0.56 ). Multivariate analysis after adjusting confounders showed that retention of ARM lymph nodes or not during operation was independent risk factor for upper extremity lymphedema ( P=0.02，OR=16.39). The risk of upper extremity lymphedema in ALND with ARM failed was 15.4 times more than that in ARM lymph node preserved ALND. Conclusion Preserving ARM lymph nodes during breast cancer operation could effectively reduce the incidence of upper extremity lymphedema after ALND.