M. Karim (Villejuif, France)
Gustave Roussy -Author Of 1 Presentation
83P - Axillary Reverse Mapping Using Near-infrared fluorescence Imaging in Invasive Breast Cancer (ARMONIC Study)
Abstract
Background
Axillary lymph node dissection (ALND) in patients with breast cancer has the potential to induce side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the breast from that of the upper limb in the axillary lymph node (LN) basin. We aimed to determine ARM node identification rate by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement.
Methods
The study enrolls 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was finally performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic’s ducts, both in case of direct surgery than neoajduvant chemotherapy.
Results
94.5% of patients had ARM nodes identified. No difference was found between the 2 groups, with or without neoajuvant chemotherapy.The ARM nodes were localized in D zone in 64.4% of cases. The rate of metastatic axillary lymph nodes was 55.3 % in the all cohort, 19.4 % also in ARM nodes with 7.7% of metastatic ARM lymph nodes in D zone. Two patients had metastatic ARM lymph nodes and not in the remaining axillary lymph nodes. Beside number of mitosis (p 0.04), no predictive factor of ARM nodes involvement was found
ARM ARM Total neg pos ALND neg 44.7% 1.9% 46.6% ALND pos 35.9% 17.4% 53.4% TOTAL 80.6% 19.4% 100%
Conclusions
Axillary reverse mapping by NIR fluorescence imaging appears as a reliable technique to identify in realtime arm node when ALND. Performing pre-operative chemotherapy, a known factor of lymphatics modification, did not significantly influence the detection rate. Our study shows that ARM node is a potential drainage route of cancer cells, finding metastasis in 19.4% of cases, raising the question on its impact on the prognosis. The collected clinical data compared with arm node histological diagnosis showed only the number of mitosis in diagnostic biopsy as a potential predictive factor of arm node involvement.
Legal entity responsible for the study
PHRC of French National Institute for Cancer.
Funding
French INCa agency (French National Institute for Cancer), grant PHRC K15-222.
Disclosure
All authors have declared no conflicts of interest.