Abstract P2-12-01: 3 years follow-up results of arm node preserving surgery
Authors: Park J , Yeu KJ , Choi JE , Kang SH , Bae YK , Lee SJ 
Published: May 2016

Background: Arm nodes can be identified by using axillary reverse mapping technique during axillary lymph node dissection. Many articles reported about feasibility of arm node preserving surgery for preventing lymphedema in breast cancer patients. But there are only a few studies about long-term follow-up results. The purpose of this study is to evaluate the incidence of lymphedema and the rate of regional recurrence and distant metastasis after arm node preserving surgery for 3 years follow-up period.

Methods: From January 2009 to October 2014, 167 breast cancer patients who underwent axillary reverse mapping were included. Before axillary lymph node dissection, 2.5mL of blue dye was injected in the medial intermuscular groove of the ipsilateral upper arm, subcutaneously. After elevation of the arm for at least 15 minutes, axillary lymph node dissection was performed. Blue-dyed lymph nodes and lymphatics were identified and preserved unless they showed radioactivity or suspiciousness for metastasis. Bilateral upper arm circumferences were measured preoperatively and postoperatively in all patients. Over 2cm circumference difference between ipsilateral and contralateral upper arm was defined as lymphedema. Follow-up studies such as ultrasound, mammography and/or PET were checked every 6 months for 5 years and then annually.

Results: 125 patients had their arm node preserved and 42 patients had their arm node removed. The mean number of harvested nodes was 17.85±6.74 in arm node preserved group and 20.17±6.08 in arm node removed group(p=0.050). The mean number of identified arm nodes was 1.35±0.84. The mean follow-up period was 40.25±20.57 months. 15 patients complained subjective symptoms of lymphedema, 3 patients in arm node preserved group and 12 patients in arm node removed group (2.4% vs 28.6, p&lt;0.001). Among them, only 6 patients in arm node removed group were diagnosed with lymphedema by objective criteria whereas in arm node preserved group, there was no actual lymphedema (14.3% vs 0%, p&lt;0.001). The mean measured circumference difference between ipsilateral and contralateral upper arm was 0.19±0.66 in arm node preserved group and 0.67±0.92 in arm node removed group (p=0.003). There were 11 cases of distant metastasis with a median time to metastasis of 30 months, 9 cases in arm node preserved group, 2 cases in arm node removed group (7.2% vs 4.8%, p=0.732). Among them, two patients whose arm nodes were preserved had ipsilateral axillary recurrence simultaneously (p=1.000). 5-year disease-free survival was 92.7% in arm node preserved group and 85% in arm node removed group (p=0.963)

Conclusion: Arm node preserving surgery during axillary lymph node dissection in breast cancer patients can reduce the incidence of lymphedema and it can be performed safely without increase of the rate of regional recurrence and distant metastasis.

Citation Format: Park J, Yeu KJ, Choi JE, Kang SH, Bae YK, Lee SJ. 3 years follow-up results of arm node preserving surgery. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-01.