Axillary Reverse Mapping in Breast Cancer

Breast Cancer-Related Lymphedema (BCRL)

“…The incidence of LE ranges from 7 % to 77 % of patients who undergo ALND. Several cooperative group trials have indicated that LE occurs at 0-23 % with SLN biopsy alone and 21-51 % after axillary radiation therapy and lymph node surgery [8][9][10]. The 5-year cumulative incidence of lymphedema is 42 %, and lymphedema first occurs within 2 years of diagnosis in 80 % of patients and within 3 years in 89 % of patients [9].…”

“…Further, there are practical issues concerning the ARM procedure that remain to be resolved: (a) insufficient identification rates of the ARM nodes and/or lymphatic vessels as well as a persistent blue stain at the site of injection; (b) the ARM nodes may be involved with metastatic foci in patients with axillary lymph node metastases; and (c) the SLNB draining of the breast may be the same as the ARM node draining of the upper extremity in a minority of patients. Therefore, further studies are needed before this technology can be included as a standard procedure in breast cancer surgical management [8,70].…”

Assessment of Postmastectomy Lymphedema and Current Treatment Approaches

“…Besides the prevention of interstitial fluid accumulation, lymphatic system has an important role in terms of antigen presentation in the immune system (2). 80 % of the lymphatic circulation of upper extremity drainages to axilla in which there are approximately 20-30 lymph nodes and removing of the axillar lymph nodes for any reason leads up to develop lymphedema in the arm of the same side (3). For this reason, the patients having breast cancer develop lymphedema frequently because of both the nature of cancer itself and treatment of cancer.…”

Lymphedema: From diagnosis to treatment

“…Recently, the lymphatic drainage of the arm and breast tissue were studied and it was found that preserving arm lymphatics during SLNB and/or ALND via a new concept called axillary reverse mapping (ARM) may reduce the risk of BCRL (4,54,55). ARM is based on the hypothesis that drainage of arm lymphatics differs from that of breast lymphatics (4, 54).…”