Axillary reverse mapping: a prospective study in women with clinically node negative and node positive breast cancer

Area of Science:

• Oncology
• Surgical Oncology
• Lymphedema Research

Background:

• Axillary reverse mapping (ARM) aims to prevent lymphedema by preserving arm lymphatics.
• Concerns about feasibility and oncologic safety have hindered ARM adoption.
• This study investigated ARM in breast cancer patients, both node-negative and node-positive.

Purpose of the Study:

• To assess the feasibility of axillary reverse mapping (ARM).
• To evaluate the identification and preservation rates of arm lymphatics using ARM.
• To investigate the oncologic safety of ARM, including SLN crossover and metastatic disease in ARM nodes.

Main Methods:

• Prospective study of 184 patients undergoing 212 ARM procedures.
• Two groups: 155 sentinel lymph node biopsies (SLNB) without axillary lymph node dissection (ALND), and 57 ALNDs with/without SLNB.
• ARM lymphatics were not preserved if they were a SLN, directly entered a SLN, or were within ALND boundaries.

Main Results:

• ARM identification rates were 47% in SLNB-only group and 72% in ALND group.
• Lymphatic preservation criteria were met by 30% and achieved in 25% of the SLNB-only group.
• 10% of ARM nodes were SLNs (crossover), with metastatic disease found in one crossover and two non-sentinel ARM nodes in node-positive patients.

Conclusions:

• ARM is a feasible technique for identifying and preserving axillary arm lymphatics.
• An acceptable incidence of SLN crossover was observed.
• Larger studies are needed to confirm lymphedema reduction and absence of ARM metastases.