Individualisation of the Lymphatic Arm Drainage During Axillary Dissection for Breast Carcinomas.
Distinct arm from breast axillary dissection (AD), or axillary reverse mapping (ARM),
involves retrieving all breast related nodes while leaving intact the main lymphatic
drainage chain of the upper limb. This represents a new surgical technique that is the focus
of recent surgical interest. The assumption is that the sentinel node (SN) of the upper limb
is different from the SN of the breast and that it is uninvolved after metastatic
involvement of the axillary nodes in relation to the breast. During the ARM procedure, it is
necessary to use an injection of a lymphatic tracer into the upper limb in order to
visualize the lymphatic arm drainage.The ultimate goal for ARM procedure is to reduce the
rate of lymphedema in N+ patients requiring an AD.
Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Success of the principal objectives is qualified as finding one or more radioactive node in zone D
Zone D is the area lateral to the lateral thoracic vein and extending from the second intercostobrachial nerve to the axillary vein. If all radioactive nodes are found below the second intercostobrachial nerve (Zone C, A) or medial to the lateral thoracic vein (Zone A, B) this qualifies a failure of the main objective
Claude NOS, MD
Assistance Publique - Hôpitaux de Paris
France: Ministry of Health