Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Abstract

Background The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was developed to prevent breast-cancer related lymphedema (BCRL) remains controversial. Methods A comprehensive search of Medline Ovid, Pubmed, Web of Science and the Cochrane CENTRAL databases was conducted from the inception till January 2020. The key word including “breast cancer”, “axillary reverse mapping”, and “lymphedema”. Stata 15.1 software was used for the meta-analysis. Results As a result, twenty-nine related studies involving 4954 patients met our inclusion criteria. The pooled overall estimate lymphedema incidence was 7% (95% CI 4%–11%, I 2 = 90.35%, P < 0.05), with SLNB showed a relatively lower pooled incidence of lymphedema (2%, 95% CI 1%–3%), I 2 = 26.06%, P = 0.23) than that of ALND (14%, 95% CI 5%–26%, I 2 = 93.28%, P < 0.05) or SLNB and ALND combined (11%, 95% CI 1%–30%). The ARM preservation during ALND procedure could significantly reduce upper extremity lymphedema in contrast with ARM resection (OR = 0.27, 95% CI 0.20–0.36, I 2 = 31%, P = 0.161). Intriguingly, the result favored ALND-ARM over standard-ALND in preventing lymphedema occurrence (OR = 0.21, 95% CI 0.14–0.31, I 2 = 43%, P = 0.153). The risk of metastases in the ARM-nodes was not significantly lower in the patients who had received neoadjuvant chemotherapy, as compared to those without neoadjuvant treatment (OR = 1.20, 95% CI 0.74–1.94, I 2 = 49.4%, P = 0.095). Conclusions ARM was found to significantly reduce the incidence of BCRL. The selection of patients for this procedure should be based on their axillary nodal status. Preoperative neoadjuvant chemotherapy has no significant impact on the ARM lymph node metastasis rate.

Axillary Reverse Mapping in Patients Undergoing Axillary Lymph Node Dissection: A Single Institution Experience From India

“…All these patients had clinically N2 disease and all had pathologically more than ten nodes involved in the axilla. The ARM metastasis rate was ranging from 0-31 % in previous studies [11]. Researchers have found a significant positive correlation between metastatic involvement of ARM node with axillary tumor burden in terms of the number of positive axillary nodes [12,22,24,25].…”

“…ARM is a relatively new concept under evolution since its inception by Thompson et al over a decade ago [4]. There are only a few studies done till date and the data on the Indian population is even more sparse [11].…”

“…In our study, we were able to identify the blue ARM nodes or lymphatics in 65 (54.17%) out of 120 patients. The reported identification rate of ARM node/lymphatics is in the range of 47-89% in patients where the blue dye was used and ALND was done [11]. In their prospective study, Ponzone et al could identify ARM in 55% of patients, where 46 (94%) out of 49 had axillary nodal metastasis [12].…”

Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients With Locally Advanced Breast Cancer and Partial Response After Neoadjuvant Chemotherapy

“…Even in case of complete pathological response, it is uncertain whether the oncological remodeling of the lymph drainage system in the axilla regresses post neoadjuvant therapy (21,23). Indeed, in a recent systematic review, ARM node metastases rate was similar with or without NAC (39). In view of this evidence, oncological safety of ARM technique in our opinion should be considered firstly in patients with a lower risk of progression, as in patients with a complete radiological response post NAC (40).…”

The effectiveness of axillary reverse mapping in preventing breast cancer-related lymphedema: a meta-analysis based on randomized controlled trials

“…A recent meta-analysis reviewed 29 studies, involving 4,954 patients, which clinically applied ARM in patients with BC. The results suggested that applying ARM during ALND led to a significant reduction in arm lymphedema compared to ARM resection (28). The 5 RCTs in this metaanalysis, which included 1,659 patients, were carried out with different inclusion criteria and follow-up times.…”