Identification and Preservation of Arm Lymphatic System in Axillary Dissection for Breast Cancer to Reduce Arm Lymphedema Events: A Randomized Clinical Trial

Journal Article · Tue Oct 15 04:00:00 EDT 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-019-07569-4· OSTI ID:22927570

Yuan, Qianqian; Wu, Gaosong ^[1]; Xiao, Shu-Yuan ^[2]; Hou, Jinxuan; Ren, Yuqi; Wang, Hongying ^[1]; Wang, Kun; Zhang, Dan ^[3]

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1. Zhongnan Hospital of Wuhan University, Department of Thyroid and Breast Surgery (China)
2. Wuhan University Center for Pathology and Molecular Diagnostics (China)
3. Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Department of Thyroid and Breast Surgery (China)

Background: Controversy in axillary reverse mapping in axillary lymph node dissection (ALND) possibly results from incomplete recognition of the arm lymphatic system (ALS) and its compromise to oncological safety. The iDEntification and Preservation of ARm lymphaTic system (DEPART) technique facilitates complete identification of ALS; therefore, its use may decrease the occurrence of arm lymphedema. This study aimed to examine the arm lymphedema rate, locoregional recurrence, and feasibility to perform DEPART in ALND. Methods: Patients from February 2013 to October 2017 from two tertiary referral centers were randomly assigned to two groups. In the study group, indocyanine green and methylene blue (MB) were utilized to identify arm sentinel nodes, and 0.1 ml MB was injected into the arm sentinel nodes to reveal the subsequent-echelon nodes and lymphatics. Gross arm lymph nodes were examined by intraoperative partial frozen section and were removed if positive. Arm lymphedema, local recurrence, regional recurrence, and distant metastasis were recorded at different follow-up examinations. Results: Arm sentinel nodes were identified in 573 (83.2%) patients. Subsequent-echelon nodes and lymphatics were visualized in 558 (97.4%) patients. Metastatic arm nodes were identified in 38 (6.8%) patients. The arm lymphedema rate was 3.3% (18/543) in the study group versus 15.3% (99/648) in the control group (p < 0.001) after 37-month median follow-up. Regional recurrence showed no difference between the two groups (1.4% and 1.2%, respectively) (p = 0.392). Conclusions: DEPART can benefit breast cancer patients who undergo ALND, reducing the arm lymphedema rate without adversely affecting the morbidity of regional recurrence.

• OSTI ID: 22927570
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 11 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CLINICAL TRIALS
DISEASE INCIDENCE
INDOCYANINE GREEN
LYMPH NODES
MAMMARY GLANDS
METASTASES
METHYLENE BLUE
NEOPLASMS
PATIENTS