Axillary reverse mapping: towards selective axillary surgery in breast cancer patients

There is still a considerable number of patients with breast cancer who are eligible for an axillary lymph node dissection (the removal of all axillary lymph nodes). However, a major disadvantage to this procedure is the potential occurrence of considerable discomfort to the patient: lymphedema in particular, but also sensory and movement disorders. This disseration describes the introduction of a new technique called axillary reverse mapping (ARM). The underlying principle of this technique is the anatomical position of the lymphatic drainage system: both ‘chest’ and ‘arm’ lymph nodes are located in the axilla. Generally speaking, these cannot be differentiated from each other during surgery. The concept of the ARM procedure is mapping the lymphatic drainage of the arm, allowing this system to be spared during an axillary lymph node dissection. The mapping is performed through injection of a blue colourant in the medial side of the upper arm. As a result, all ‘arm’ lymph nodes and connected lymphatic vessels turn blue, allowing them to be selectively spared. In this way, the risk of developing lymphedema may be reduced without adversely affecting the effectiveness of the treatment for patients with breast cancer.