Can axillary reverse mapping avoid lymphedema in node positive breast cancer patients?

Area of Science:

• Oncology
• Surgical Oncology
• Lymphedema Research

Background:

• Axillary reverse mapping (ARM) traces lymphatic drainage from the ipsilateral arm in node-positive breast cancer patients.
• Recent reports describe ARM as a novel technique for guiding lymph node dissection.

Purpose of the Study:

• To analyze the experience with ARM in patients undergoing axillary lymph node dissection (ALND).
• To evaluate the usefulness of ARM in reducing the incidence of lymphedema post-ALND.

Main Methods:

• Blue dye and radioisotope were injected in the arm and hand, respectively, to identify lymphatic vessels and nodes.
• Suspicious "ARM lymph nodes" in the lateral axillary basin were preserved; other level I and II nodes were removed.
• Resected ARM nodes were analyzed for tumor involvement and preserved nodes were tracked for recurrence and lymphedema.

Main Results:

• ARM was performed in 143 patients; ARM lymph nodes were identified in 78%.
• Tumor involvement was confirmed in 14 of 55 patients requiring ARM node removal.
• In 71 patients, ARM nodes were preserved; no axillary recurrence was noted during a median 19-month follow-up.
• Lymphedema developed in 35 of 114 evaluated patients; ARM node preservation did not significantly decrease its incidence.

Conclusions:

• Axillary reverse mapping is a feasible surgical technique for node-positive breast cancer patients.
• Current evidence does not support ARM's effectiveness in reducing lymphedema incidence.