Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection.
BACKGROUND
Two thirds of node-positive breast cancer patients have limited pN1 disease and could benefit from a less extensive axillary lymph node dissection (ALND).


METHODS
172 breast cancers patients requiring an ALND were prospectively enrolled in the Sentibras Protocol of Axillary Reverse Mapping (ARM). Radioisotope was injected in the ipsilateral hand the day before surgery. ALND was standard. Removed lymph nodes were classified into non radioactive nodes and radioactive nodes (ARM nodes). Among ARM nodes, nodes located in the upper outer part of the axilla, above the second intercostal brachial nerve and lateral to the lateral thoracic vein were identified as "zone D ARM nodes". The main objective was: feasibility of identification of the zone D ARM nodes. Secondary objectives were: metastatic involvement and lymphedema rate.


RESULTS
100% of patients had ARM nodes identified. The "zone D ARM nodes" were identified in 92% of cases. The rate of metastatic nodes was 60% in the all cohort, 31% in ARM nodes and 9% in zone D ARM nodes. Among those, metastatic rate was 6% in patients undergoing ALND for a positive sentinel node biopsy, 6% in case of primary ALND versus 14% after neo-adjuvant chemotherapy (p < 0.05). After 34 months of median follow up, 27% of interviewed patients had a lymphedema.


CONCLUSION
The ARM technique reliably identifies the "zone D ARM nodes". These nodes can also easily be identified using knowledge of axillary anatomy. In selected patients, a selective ALND sparing the zone D ARM nodes could be performed.
['Nos|C|C|', 'Clough|K B|KB|', 'Bonnier|P|P|', 'Lasry|S|S|', 'Le Bouedec|G|G|', 'Flipo|B|B|', 'Classe|J-M|JM|', 'Missana|M-C|MC|', 'Doridot|V|V|', 'Giard|S|S|', 'Charitansky|H|H|', 'Charles-Nelson|A|A|', 'Bats|A-S|AS|', 'Ngo|C|C|']
D000328:Adult D000368:Aged D000970:Antineoplastic Agents D001365:Axilla D000072656:Breast Cancer Lymphedema D001943:Breast Neoplasms D002985:Clinical Protocols D005240:Feasibility Studies D005260:Female D006801:Humans D008197:Lymph Node Excision D008198:Lymph Nodes D008875:Middle Aged D020360:Neoadjuvant Therapy D011183:Postoperative Complications D000071036:Sentinel Lymph Node D021701:Sentinel Lymph Node Biopsy
Axillary dissection Axillary reverse mapping Lymphedema Breast carcinoma Multicentric study Sentinel lymph node dissection