{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:32:25Z","timestamp":1772818345957,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Tailored axillary surgery (TAS) and axillary reverse mapping (ARM)-guided axillary lymph node dissection (ALND) have been developed to avoid arm lymphedema without increasing a risk of axillary recurrence. However, the oncological feasibility of TAS and ARM-guided ALND remains a crucial consideration. Methods: This article reviewed the oncological feasibility of TAS and ARM-guided ALND based on the current literature. Results: For ALND performed after TAS, additional involved nodes were found in 70% of upfront surgery patients and 60% of neoadjuvant chemotherapy (NAC) patients. ARM nodes were also involved in up to 64.7% of patients after ALND. However, it is not necessary to preserve all ARM nodes and lymphatics because multiple ARM lymphatic pathways exist. Selective preservation of ARM nodes closest to the axillary vein significantly reduced the incidence of involved ARM nodes (from 64.7% to 15.7%). Conclusions: TAS and ARM-guided ALND remain much less radical than ALND. However, residual nodal disease after TAS or ARM-guided ALND does not always develop axillary recurrence. Postoperative irradiation is effective in achieving local control in patients with low-volume (microscopic) residual nodal disease after TAS or ARM-guided ALND. We await the long-term results of prospective randomized clinical trials comparing TAS and ARM-guided ALND with conventional ALND.<\/jats:p>","DOI":"10.3390\/cancers18050854","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:05:44Z","timestamp":1772795144000},"page":"854","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oncological Feasibility of Conservative Axillary Surgery (Opinion Article): Tailored Axillary Surgery vs. Axillary Reverse Mapping-Guided Axillary Lymph Node Dissection"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2896-0164","authenticated-orcid":false,"given":"Masakuni","family":"Noguchi","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada, Kahoku 920-0293, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Haba","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada, Kahoku 920-0293, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emi","family":"Morioka","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada, Kahoku 920-0293, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8886-9517","authenticated-orcid":false,"given":"Masafumi","family":"Inokuchi","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada, Kahoku 920-0293, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1097\/SLA.0000000000005671","article-title":"Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients. Systemic review and meta-analysis","volume":"277","author":"Bakri","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0960-7404(93)90064-6","article-title":"Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe","volume":"2","author":"Krag","year":"1993","journal-title":"Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00000658-199409000-00015","article-title":"Lymphatic mapping and sentinel lymphadenectomy for breast cancer","volume":"220","author":"Giuliano","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/S1470-2045(10)70207-2","article-title":"Sentinel \u2013lymph-node resection compared with conventional axillary-lymph-node resection in clinically node-negative patients with breast cancer: Overall survival findings from the NSABP B-32 randomised phase 3 trial","volume":"11","author":"Krag","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/SLA.0b013e3181c0e92a","article-title":"Sentinel lymph node biopsy in breast cancer. Ten-year results of a randomized controlled study","volume":"251","author":"Veronesi","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/SLA.0b013e3181f08f32","article-title":"Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. The American College of Surgeons Oncology Group Z0011 randomized trial","volume":"252","author":"Giuliano","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/S1470-2045(14)70460-7","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomized, multicenter open-label, phase 3 non-inferiority trial","volume":"15","author":"Donker","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3467","DOI":"10.1245\/s10434-016-5246-8","article-title":"How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases: Results of a prospective study","volume":"26","author":"Mamtani","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e438776","DOI":"10.1200\/EDBK_438776","article-title":"Personalizing locoregional therapy in patients with breast cancer in 2024: Tailoring axillary surgery, escalating lymphatic surgery, and implementing evidence-based hypofractionated radiotherapy","volume":"44","author":"Weber","year":"2024","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Heidinger, M., and Weber, W.P. (2024). Axillary surgery for breast cancer in 2024. Cancers, 16.","DOI":"10.3390\/cancers16091623"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.jamcollsurg.2013.12.041","article-title":"Conservative axillary surgery in breast cancer patients undergoing mastectomy: Long-term results","volume":"218","author":"Cowher","year":"2014","journal-title":"J. Am. Coll. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.breast.2021.09.004","article-title":"Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23\/16, IBCSG 57-18, ABCSG-53, GBG 101)","volume":"60","author":"Weber","year":"2021","journal-title":"Breast"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/j.breast.2021.08.018","article-title":"Axillary surgery in node-positive breast cancer","volume":"62","author":"Maggi","year":"2022","journal-title":"Breast"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1177\/030006051204000632","article-title":"Partial lower axillary dissection for patients with clinically node-negative breast cancer","volume":"40","author":"Kodama","year":"2012","journal-title":"J. Int. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1245\/s10434-007-9412-x","article-title":"Axillary reverse mapping (ARM): A new concept to identify and enhance lymphatic preservation","volume":"14","author":"Thompson","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1245\/s10434-007-9450-4","article-title":"Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection","volume":"14","author":"Nos","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s12282-022-01409-2","article-title":"Conservative axillary surgery is emerging in the surgical management of breast cancer","volume":"30","author":"Noguchi","year":"2023","journal-title":"Breast Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Noguchi, M., Inokuchi, M., Yokoi-Noguchi, M., Morioka, E., and Haba, Y. (2023). Conservative axillary surgery may prevent arm lymphedema without increasing axillary recurrence in the surgical managing of breast cancer. Cancers, 15.","DOI":"10.3390\/cancers15225353"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.breast.2023.03.005","article-title":"Tailored axillary surgery\u2014A novel concept for clinically node positive breast cancer","volume":"69","author":"Heidinger","year":"2023","journal-title":"Breast"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7151","DOI":"10.1158\/0008-5472.CAN-13-1888","article-title":"It is not always necessary to do axillary dissection for T1 and T2 breast cancer","volume":"73","author":"Morrow","year":"2013","journal-title":"Cancer Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1056\/NEJM198503143121102","article-title":"Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation","volume":"312","author":"Fisher","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Henke, G., Knauer, M., Ribi, K., Hayoz, S., Gerard, M.-A., Ruhstaller, T., Zwahlen, D.R., Muenst, S., Ackerknecht, M., and Hawle, H. (2018). Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): Study protocol for a multicenter, randomized phase-III trial. BMC, 19.","DOI":"10.1186\/s13063-018-3021-9"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1470-2045(25)00598-4","article-title":"Oncoplastic outcomes with and without axillary lymph node dissection in patients with residual micrometastases after neoadjuvant chemotherapy (OPBC-07\/microNAC): An international, retrospective cohort study","volume":"27","author":"Montagna","year":"2026","journal-title":"Lancet Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3446","DOI":"10.1245\/s10434-019-07569-4","article-title":"Identification and preservation of arm lymphatic system in axillary dissection for breast cancer to reduce arm lymphedema events: A randomized clinical trial","volume":"26","author":"Yuan","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.clbc.2015.01.010","article-title":"A prospective study to assess the feasibility of axillary reverse mapping and evaluate its effect on preventing lymphedema in breast cancer patients","volume":"15","author":"Yue","year":"2015","journal-title":"Clin. Breast Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/j.clbc.2022.10.008","article-title":"Axillary reverse mapping in the prevention of lymphoedema: A systemic review and pooled analysis","volume":"23","author":"Co","year":"2023","journal-title":"Clin. Breast Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ejso.2019.08.003","article-title":"A patient- and assessor-blinded randomized controlled trial of axillary reverse mapping (ARM) in patients with early breast cancer","volume":"46","author":"Beek","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13037-019-0217-1","article-title":"Prevention of lymphedema via axillary reverse mapping for arm lymph-node prevention following breast cancer surgery: A randomized controlled trial","volume":"13","author":"Faisal","year":"2019","journal-title":"Patient Saf. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ijsu.2020.01.152","article-title":"Evaluation of axillary reverse mapping (ARM) in clinically axillary node negative breast cancer patients \u2013Randomized controlled trial","volume":"75","author":"Abdelhamid","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4185","DOI":"10.1002\/cncr.34498","article-title":"Occurrence of breast \u2013cancer-related lymphedema after reverse lymphatic mapping and selective axillary versus standard surgical treatment of axilla: A two-arm randomized clinical trial","volume":"128","author":"Gennaro","year":"2022","journal-title":"Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1097\/01.prs.0000246516.64780.61","article-title":"The lymphatic territories of the upper limb: Anatomical study and clinical implications","volume":"119","author":"Suami","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.ejso.2012.01.010","article-title":"Analysis of direct oil contrast lymphography of upper limb lymphatics traversing the axilla \u2013a lesson from the past contribution to the concept of axillary reverse mapping","volume":"38","author":"Pavlista","year":"2012","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.breast.2020.08.007","article-title":"Clinical application of axillary reverse mapping in patients with breast cancer: A systemic review and meta-analysis","volume":"53","author":"Wijaya","year":"2020","journal-title":"Breast"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1002\/jso.21473","article-title":"Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer","volume":"101","author":"Noguchi","year":"2010","journal-title":"J. Surg. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7271","DOI":"10.21276\/SSR-IIJLS.2025.11.2.42","article-title":"Prospective study of axillary reverse mapping using indocyanine green in breast cancer","volume":"11","author":"Krishna","year":"2025","journal-title":"SSR Inst. Int. J. Life Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1002\/jso.24859","article-title":"Axillary reverse mapping with indocyanine green or isosulfan blue demonstrate similar crossover rates to radiotracer identified sentinel nodes","volume":"117","author":"Foster","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jss.2024.11.043","article-title":"Higher rates of visualization for axillary reverse mapping using indocyanine green fluorescence compared with blue dye","volume":"306","author":"Jupitz","year":"2025","journal-title":"J. Surg. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1002\/jso.23528","article-title":"Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphoedema in breast cancer patients undergoing sentinel node biopsies","volume":"109","author":"Sakurai","year":"2014","journal-title":"J. Surg. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"8701","DOI":"10.1245\/s10434-025-17703-0","article-title":"Indocyanine green fluorescence-guided axillary reverse mapping for axillary lymph node dissection in breast cancer: The FARM trial","volume":"32","author":"Nguyen","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"106937","DOI":"10.1016\/j.ejso.2023.05.012","article-title":"The involvement of axillary reverse mapping nodes in patients with node-positive breast cancer","volume":"49","author":"Noguchi","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_41","first-page":"268","article-title":"Axillary reverse mapping using indocyanine green in breast cancer: Standardization of the technique","volume":"25","author":"Pla","year":"2024","journal-title":"Clin. Breast Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/1477-7819-10-233","article-title":"Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients","volume":"10","author":"Ikeda","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/mco2.31","article-title":"Comparison of indocyanine green and methylene blue use for axillary reverse mapping during axillary lymph node dissection","volume":"1","author":"Wu","year":"2020","journal-title":"MedComm"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4048\/jbc.2012.15.1.91","article-title":"The efficacy of arm node preserving surgery using axillary reverse mapping for preventing lymphedema in patients with breast cancer","volume":"15","author":"Han","year":"2012","journal-title":"J. Breast Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"290","DOI":"10.32768\/abc.2024113290-296","article-title":"Intraoperative nodal palpation is a mandatory component of sentinel lymph node biopsy for breast cancer","volume":"11","author":"Noguchi","year":"2024","journal-title":"Arch. Breast Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1097\/SLA.0000000000001778","article-title":"Does axillary reverse mapping prevent lymphedema after lymphadenectomy?","volume":"265","author":"Tummel","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1055\/s-2006-947150","article-title":"Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities","volume":"16","author":"Koshima","year":"2000","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1200\/JCO.2015.62.3504","article-title":"Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: Results from the International Breast Cancer Study Group Trials I to V","volume":"34","author":"Colleoni","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1056\/NEJMoa1701830","article-title":"20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years","volume":"377","author":"Pan","year":"2017","journal-title":"N. Engl. J. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/854\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:23:10Z","timestamp":1772796190000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["cancers18050854"],"URL":"https:\/\/doi.org\/10.3390\/cancers18050854","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]}}}