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Does Axillary Reverse Mapping Prevent Lymphedema After Lymphadenectomy?

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  • 1*Departments of Surgery, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Institute, Little Rock, AR †Departments of Pathology, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Institute, Little Rock, AR ‡Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR.

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Summary

Axillary reverse mapping (ARM) helps surgeons identify and preserve arm lymphatics during breast cancer surgery, significantly reducing lymphedema risk after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). This technique improves patient outcomes by minimizing post-operative swelling.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Lymphedema Research

Background:

  • High rates of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may stem from unrecognized lymphatic drainage variations.
  • Axillary reverse mapping (ARM) aims to identify and preserve these arm lymphatics during surgery.

Purpose of the Study:

  • To evaluate the effectiveness of ARM in reducing lymphedema rates.
  • To assess the impact of ARM on lymphatic identification and preservation during breast cancer surgery.

Main Methods:

  • Prospective study of 654 patients undergoing SLNB and/or ALND with ARM from 2007-2013.
  • ARM involved injecting isosulfan blue dye in the upper arm to visualize non-breast lymphatics.
  • Data collected included lymphatic identification, crossover, metastases, recurrence, and lymphedema rates.

Main Results:

  • Lymphedema rates were 0.8% for SLNB and 6.5% for ALND, with a median follow-up of 26 months.
  • Arm lymphatics were identified in 29.2% of SLNB and 71.8% of ALND procedures.
  • Metastases in non-crossover nodes and axillary recurrence rates were low.

Conclusions:

  • ARM enables frequent identification and preservation of axillary arm lymphatics.
  • The use of ARM is associated with dramatically reduced lymphedema rates compared to historical controls.
  • ARM is a valuable technique for minimizing lymphedema after axillary procedures in breast cancer patients.