Axillary reverse mapping (ARM): where to go

In the past decades, breast surgeons have changed the clinical practice in the surgical treatment of breast cancer, by performing sentinel lymph node biopsy (SLNB) instead of performing axillary lymph node dissection (ALND) in axillary lymph node clinically negative breast cancer patients. ALND can also be avoided in SLN-positive patients who meet the Z-0011 criteria. However, the postoperative complications of SLNB and ALND, such as the secondary upper extremity lymphedema, are common and need effective solutions to prevent as soon as possible. The axillary reverse mapping (ARM) technique has been developed to map and preserve arm lymphatic drainage during ALND and/or SLNB, thereby minimizing arm lymphedema. However, the success of ARM in reducing lymphedema has not been exactly determined. If ARM can be confirmed to be both effective and oncologically safe in preventing lymphedema, this technique should be recommended in the management of breast cancer treatment.