Using indocyanine green and methylene blue for axillary reverse mapping in modified radical mastectomy for breast cancer

Abstract

Axillary Reverse Mapping (ARM) is a method used to identify the lymph nodes (known as ARM nodes) and lymphatic vessels of the upper limb that pass through the axillary region during breast cancer surgery. It is also known as DUAL mapping or SPLIT mapping. The main goal of ARM is to decrease the occurrence of arm lymphedema. This is based on the hypothesis that the ARM procedure reveals an alternative lymphatic pathway originating from the arm. To assess the rates of intraoperative identification and metastasis of ARM nodes. The ARM node identification rate was 83.33%. In our study, the visualization rate in the methylene blue plus ICG group was significantly higher at 95.8% (23 out of 24) compared to 75% (18 out of 24) in the methylene blue alone group. Using methylene blue combined with ICG for ARM achieves a higher identification rate of ARM nodes compared to methylene blue alone, making it a promising technique for surgical treatment in patients with invasive breast cancer.