One of the major morbidities of breast cancer surgery is lymphoedema related to axillary lymph node dissection(ALND). Sentinel node biopsy(SNB) and avoiding ALND whenever feasible are effective. Identifying the nodes draining the upper extremity (Axillary Reverse Mapping/ARM) is a promising method for reducing lymphoedema. We aimed to assess the feasibility of ARM in our setting.

A prospective study was conducted between February 2020 and February 2023 in histologically proven, non-metastatic, early(cT1-2, N0-1) breast cancer patients planned for surgery first, after obtaining Institutional Ethics clearance and informed consents. (CTRI/2020/02/023631) All patients underwent mastectomy or breast conservation along with methylene blue SNB guided low axillary sampling(SNB-LAS), and ARM using indocyanine green(ICG). Data was analysed in SPSS V-25.

Eighty-eight patients underwent the study procedure. Median age was 49(28–79) years. Median pathological tumour size was 2.8(0.8–8)cm, 69(78.4%) were hormone receptor positive, 32(36.4%) HER2 + . The SLN, ARM and both were identified in 78/88(88.6%), 66/88(75%) and 61/88(69.3%) patients, respectively. In 24/61(39.3%) patients, the SNB-LAS node was the same as the ARM node(defined as cross-over). In 49/66(74.2%) patients, the ARM node was within the boundaries of LAS. Overall, axillary nodal positivity rate was 40/88(45.4%), and a median of 2(1–28) nodes were involved. ARM node was positive in 16/66(24.2%) patients.

ARM node was identified in 75%, it was the same node as the SLN in 1/3rd cases and metastatic in 1/4th cases. Considering the high nodal burden and high crossover rate, the feasibility of routine ARM preservation in our cohort appears limited. Larger studies are needed, and other preventive methods should be explored in future clinical trials to reduce the risk of lymphoedema.