"Use of Axillary Reverse Mapping to Prevent Lymphedema During Breast Cancer Treatment: A Systematic Review"

The incidence of lymphedema may be as high as 65% among breast cancer patients, varying according to the diagnostic method and locoregional treatment. Therefore, investigations of preventive methods are highly welcomed. Our goal was to conduct a systematic review of the literature about the use of axillary reverse mapping to prevent lymphedema during breast cancer treatment. We hypothesized that identification of arm-draining lymph nodes may decrease the incidence of lymphedema.

On October 7, 2019, we conducted a systematic review of studies in PubMed, Cochrane Clinical Answers, and Cochrane Central Register of Controlled Trials, without time frame or language limitations, on the use of axillary reverse mapping to prevent lymphedema during breast cancer treatment. We excluded articles that investigated other uses of lymphoscintigraphy, such as lymphedema diagnosis or treatment evaluation.

Of 104 potential articles found in the literature, 5 studies fulfilled the eligibility criteria. A total of 501 patients were included. Reverse mapping was done with radiography or single-photon emission computed tomography/computed tomography. Moreover, the examination was applied with different treatments, such as axillary lymph node dissection or radiotherapy, allowing preservation of noncompromised lymph nodes. Axillary reverse mapping also had prognostic value and was used with sentinel lymph node biopsy to identify patients at higher risk for lymphedema. Only one study compared the incidence of lymphedema between patients who received standard care or reverse mapping, showing significant benefits of its use.

Use of axillary reverse mapping to prevent lymphedema is feasible and seems to provide valuable information for breast cancer treatment. Future studies that compare reverse mapping and standard care are still necessary.