Reverse Axillary Mapping in Breast Cancer Using Blue Dye: A Tertiary Setup Experience

Abstract

The concept of reverse axillary mapping originated with the main purpose of reducing lymphedema. In this study, we test the advantage of reverse axillary mapping to delineate the arm-draining lymph nodes and their involvement in various stages of breast carcinoma. In this study, we also attempt to redefine the template for axillary dissection in breast cancer. During the period of September 30, 2020, to August 30, 2021, 46 patients were recruited to undergo a procedure in which isosulfan blue dye was injected into the upper arm and the axilla was explored to isolate the lymph nodes. The lymph nodes were submitted for examination histopathologically. The results conclusively showed that axillary lymph node metastasis was only influenced by the advanced stage of the disease (p=0.014) and the visualization of the lymphatics was independent of the stage, type of surgery, decubitus, or age. The study conclusively shows that attempts to preserve the upper limb-draining nodes in advanced stages would be futile and the preservation of such lymph nodes should be limited to the early stages of breast cancer.

Keywords: blue dye; breast cancer research; general surgery and breast cancer; india; reverse axillary mapping.

Figure 1. Lymph node metastasis seen in the axillary reverse mapping (ARM) node as compared to the American Joint Committee on Cancer (AJCC) stage

Figure 2. Visualization of lymphatics in relation to the American Joint Committee on Cancer (AJCC) stage

Figure 3. Visualized ARM node stained with blue dye (pink arrow)

ARM: axillary reverse mapping

Figure 4. Discoloration leading to temporary tattooing