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Technetium Tc 99m Sulfur Colloid

During surgery, the technetium-99m sulfur colloid will be injected into the breast and the blue dye injected (if the patient is not allergic and it is not required to locate the SLN) in the patient's ipsilateral upper arm. The lymph node biopsy and/or dissection will be performed by the surgeon, according to standard practice.

Axillary Reverse Mapping

Daniela Ochoa, MD

We hypothesize that variations in anatomic location of the arm lymphatic drainage system put the arm lymphatics at risk for disruption during a SLNB and / or ALND. Therefore, mapping the drainage of the arm during the procedure would decrease the likelihood of inadvertent disruption of the lymphatics and the subsequent development of lymphedema. A combination of radioactivity and blue dye will be used.

Mapping Procedure:

Each patient will receive an injection of 1.0 mCi of technetium-99m sulfur colloid into the normal breast tissue surrounding the primary cancer or biopsy cavity directed subareolar or around the tumor.

If the radioactive SLN cannot be located prior to incision via gamma probe then the blue dye will be used in the breast either in the subareolar plexus or peritumorally at the discretion of the surgeon. For this contingency (expected to occur \<3% of the time), the blue dye will be used in the breast (and NOT the arm), as the prime concern is locating the SLN for staging.

If the blue dye is unnecessary to find the sentinel node draining from the breast, then it will be injected dermally in the upper inner arm along the Biceps groove of the ipsilateral arm in order to locate the draining lymphatics from the arm. No more than 5cc of blue dye will be injected in either the subareolar plexus, peritumorally (intraparenchymal or dermally), or dermally in the patient's ipsilateral arm dependent upon the contingencies stated above. Site of all injections (radioactivity and/or blue dye) will be recorded.

ARM: Axillary Reverse Mapping, A Prospective Study

An occurrence will consist of an increase of 20% or more in ipsilateral arm volume over the pre-surgery volume, and be accompanied by a confirmatory diagnosis of lymphedema from the UAMS lymphedema clinic.

successful localization of one or more lymph nodes to which the peritumoral breast region drains

brief location details will also be collected.

successful avoidance of resection and/or successful preservation of structural integrity of arm lymphatics during the surgical procedure.

A crossover event will consist of identification of one or more lymph nodes that are both focally radioactive following peritumoral Tc99m injection and noticeably stained blue following ipsilateral arm injection with Lymphazurin.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Axillary Reverse Mapping	NCT00572481	Cancer of the B...	Axillary Revers...	18 Years -	University of Arkansas
Axillary Reverse Mapping	NCT00572481	Cancer of the B...	Axillary Revers...	18 Years -	University of Arkansas
Axillary Reverse Mapping	NCT00572481	Cancer of the B...	Axillary Revers...	18 Years -	University of Arkansas
Axillary Reverse Mapping	NCT00572481	Cancer of the B...	Axillary Revers...	18 Years -	University of Arkansas

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