Abstract: Abstract: Objective To investigate the relationship between axillary reverse mapping (ARM), tracer dosage and detection rate of upper lymph nodes, and analyze the feasibility of ARM in preventing breast cancer related lymphedema. Methods Seventy patients diagnosed as T1- 2N0- 1M0 stage and underwent the ARM procedure from January 2014 to June 2015 were enrolled in this study. The patients were divided into low dose tracer group (0.5mL, n=40) and high dose tracer group (2 mL, n=30) randomly. The carbonnano was used as tracer to perform ARM procedure. The ARM lymph nodes and axillary lymph nodes were identified by pathological examination. The limb edema was assessed at 6 and 12 months after the operation by RVC index. Results The detective rates were 60% (24/40) and 96.7% (29/30) in low dose group and high dose group respectively, the difference was statistically significant. Of the 22 patients, the positive rate of removed one upper lymph node was (4.54%), while the metastasis rate was 38.7% in other 31 patients who removed more than two ARM nodes (P<0.05). The metastasis rate of the patients who removed more than two ARM nodes was not increased compared with that of patients removed two ARM nodes (P=0.717). Moreover, after a 12-month follow-up, the relative volume change (RVC) of lymphedema was obviously increased in patients who removed more than two ARM nodes (P < 0.05). Conclusion High dose tracer can increase the detective rate of ARM nodes. The removing two ARM nodes in ARM procedure is recommend, which not only can ensure the pathological diagnosis of node, but also prevent the lymphedema of wounded limb.

Key words: breast neoplasms, lymph nodes, lymphedema, axillary reverse mapping, axillary reverse mapping node