Role of Axillary Reverse Mapping in Breast Cancer to Decrease Complications

Introduction: The concept of axillary reverse mapping (ARM) is to map this part of upper limb drainage. If lymphedema ofthe upper extremity is caused by removing lymphatics and nodes situated in the axilla, theoretically the ability to map theselymphatics would enable surgeons to preserve them.Aim: The aim of the study was to study the effect of ARM technique on the incidence of seroma and lymphedema after modifiedradical mastectomy (MRM).Materials and Methods: A prospective, randomized, and controlled study over 40 female patients who underwent MRM. Patientswere divided and randomized into study and control groups, 20 patients for each. In the study group, the ARM procedure wasdone by injecting 2.5 ml of methylene blue dye intradermally and subcutaneously in the upper inner ipsilateral arm along themedial intramuscular groove before axillary lymph node dissection. Operative and post-operative results were recorded.Results: ARM procedure and successful visualization of arm lymphatics were achieved in 17 patients (85%). Statistically,there was no significant difference between the two groups regarding patient and tumor characteristics, operative time anda number of excised lymph nodes. There was significant difference favoring the ARM group in decreasing the incidence ofseroma, lymphedema and time passed till remove drains.Conclusion: ARM procedure facilitated arm lymphatics visualization. It is an easy non-time-consuming procedure. It resulted in asignificant reduction in the incidence of seroma and lymphedema, with a considerable reduction in the overall complications rate.

Is axillary reverse mapping in patients with breast cancer oncologically safe? / 中华普通外科杂志

Objective To evaluate the oncological safety of axillary reverse mapping in patients with breast cancer.Methods Patients with sentinel lymph node biopsy(SLNB) or axillary lymphnode dissection (ALND) between Oct 2015 and Feb 2016 were enrolled in this study prospectively.Axillary reverse mapping (ARM) procedure was done using a radioisotope before the surgery.All the ARM nodes were identified and sent separately for histologic analysis.Results 78 patients underwent 78 axillary operations.Of 53 patients with SLNB,33 (62.3％)had ARM nodes identified.22 (41.5％)had the crossover of the ARM nodes with the SLNs,and one (4.5％) had positive ARM node.Of 36 patients with ALND,33 (91.7％) had ARM nodes identified.9(25％)had positive ARM nodes.Positive ARM node status was significantly associated with advanced axillary disease(P =0.036).Conclusion Preserving ARM nodes in SLNB is oncologically safe to reduce upper extremity lymphedema.

Axillary reverse mapping in surgical treatment of breast cancer / 国际肿瘤学杂志

Axillary reverse mapping (ARM) is anatomic theoretical foundation based on breast and upper limb lymph axillary lymph injected into different lymphatic populations, ARM can display upper limb lymphatic channels through different tracers during the periods of axillary lymph node dissection and sentinel lymph node dissection, to reduce the rate of postoperative upper extremity edem.Although ARM has a positive effect, it exists a controversy in safety and the relationship between its node and sentinel lymph node.

Research progress of axillary reverse mapping:A new technique to minimize arm lymphedema after breast cancer surgery / 中国肿瘤临床

Axillary reverse mapping (ARM) is a technique used to map and preserve arm lymphatic drainage during axillary lymph node dissection (ALND) and/or sentinel lymph node dissection (SLND). As a result, the risk of arm lymphedema is reduced. ARM is an emerging technology for breast cancer surgery and currently in the clinical trial phase. In this article, related clinical trials conducted in recent years were reviewed and the displaying methods of ARM lymph nodes and lymphatic vessels were analyzed. The feasibility of retained ARM lymph nodes and lymphatic vessels was also evaluated. Furthermore, the clinical significance of ARM was evaluated in terms of the reduction of the incidence of upper extremity lymphedema after breast cancer surgery.

Axillary reverse mapping by dye method in 300 breast cancer patients / 中国肿瘤临床

Objective:To assess the ability of axillary reverse mapping (ARM) to identify and preserve the arm lymphatics drainage as well as determine its ability to reduce lymphedema. Methods:A total of 300 breast cancer patients who underwent axillary lymph node dissection (ALND) from June 2009 to May 2011 were enrolled in this study. Methylene blue dye (2 mL to 3 mL) was injected into the ipsilateral upper inner arm along the medial intramuscular groove to map the upper extremity lymphatic drainage system prior to ALND. The blue lymphatic and lymph nodes were identified and preserved during the operation. The change in the arm circumference was the selected method of measurement. The difference in the bilateral upper arm circumference was recorded after 2 months (difference≥2 cm is defined as lymphedema). Results:The ARM was performed successfully in 195 (65%) of 300 patients. The incidence of lymphedema was significantly lower in the successfully mapped patients than in the failing mapping patients, with statistically significant difference during follow-up at 6, 12, 18, and 24 months post operation. Conclusion:The ARM technique can identify and preserve the arm lymphatics drainage and prevent upper extremity lymphedema after breast cancer axillary lymphadenectomy.

Axillary reverse mapping in breast cancer surgery / 国际肿瘤学杂志

The axillary reverse mapping (ARM) is a new minimally invasive technique, which has been developed to map and preserve arm lymphatic drainage during axillary lymph node dissection (ALND)and/or sentinel lymph node (SLN) biopsy, thereby minimizing arm lymphedema.