Feasibility study of axillary reverse mapping for patients with clinically node-negative breast cancer

Noguchi, Masakuni; Ohno, Yukako; Morioka, Emi; Nakano, Yukiko; Kosaka, Takeo; Kurose, Nozomu; Minato, Hiroshi

doi:10.1016/j.ejso.2016.02.244

Cited by 20 publications

(28 citation statements)

References 30 publications

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“…Twenty-nine articles published between January 2007 and January 2020 describing studies of 4954 patients were included in this meta-analysis [ 1 , 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. These included four randomized controlled trials [ 1 , [20] , [21] , [22] ] and 25 prospective non-randomized studies [ 2 , [6] , [7] , [8] , [9] , 11 , [14] , [15] , [16] , [17] , [18] , [19] , [23] , [24] , [25] ]. Four randomized controlled trials were at low risk of bias according to the Cochrane Collaboration’s tool( Table S2 ).…”

Section: Resultsmentioning

confidence: 99%

“…(2016) [ 26 ] Prospective Australia ALND alone (87) Blue dye ALND: 77%(67/87) 9%(3/32) 27%(18/67) NA NA Moderate quality 06/2012–12/2014 Noguchi et al. (2016) [ 2 ] Prospective Japan SLNB with or without ALND(292); ALND with SLNB (48) Blue dye + fluorescence SLND: 31% (90/292) ALND: 86%(36/42) 27%(77/286) 21%(19/90) SLNB: 1%(2/244) 45 months Moderate quality 06/2012–12/2014 Nos et al. (2016) [ 34 ] Prospective France ALND alone (172) Radioisotope ALND: 100%(172/172) NA 31%(54/172) SLNB + ALND: 27% 34 months Moderate quality 12/2009–12/2012 Kumar et al.…”

Section: Resultsmentioning

confidence: 99%

“…Its occurrence is mainly due to the unnecessary sacrifice of the lymphatics of the arm. Nowadays, sentinel lymph node biopsy (SLNB) is widely used to avoid unnecessary axillary lymph node dissection (ALND) in clinically node-negative patients (cN0) [ 2 ]. As such, SLNB has reduced – but not eliminated – surgical complications in patients who forgo ALND.…”

Section: Introductionmentioning

confidence: 99%

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

Wijaya¹,

Peng²,

et al. 2020

The Breast

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wijaya¹,

Peng²,

et al. 2020

The Breast

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“…However, ARM lymph nodes and lymphatics cannot, and potentially should not, always be spared. There have been incidences of the SLN coinciding with the ARM node in some patients (95,96,106,(110)(111)(112)(113)(117)(118)(119)(120), and studies have reported ARM/SLN crossover rates anywhere between 0-28% (96,100,101,103,104,106,(110)(111)(112)(113)(114)(115)(116)(118)(119)(120)(121)(122). This is not surprising because research has shown that interconnections do exist between the two, relatively independent drainage pathways (123).…”

Section: Improving Treatment Techniquesmentioning

confidence: 99%

Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments

et al. 2018

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Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer treatment, and well-established risk factors include axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR). BCRL affects approximately 1 in 5 patients treated for breast cancer, and it has a significant negative impact on patients' quality of life after breast cancer treatment, serving as a reminder of previous illness. This paper is a comprehensive review of the current evidence regarding BCRL risk factors, precautionary guidelines, prospective screening, early intervention, and surgical and non-surgical treatment techniques. Through establishing evidence-based BCRL risk factors, researchers and clinicians are better able to prevent, anticipate, and provide early intervention for BCRL. Clinicians can identify patients at high risk and utilize prospective screening programs, which incorporate objective measurements, patient reported outcome measures (PROM), and clinical examination, thereby creating opportunities for early intervention and, accordingly, improving BCRL prognosis. Innovative surgical techniques that minimize and/or prophylactically correct lymphatic disruption, such as axillary reverse mapping (ARM) and lymphatic-venous anastomoses (LVAs), are promising avenues for reducing BCRL incidence. Nonetheless, for those patients with BCRL who remain unresponsive to conservative methods like complete decongestive therapy (CDT), surgical treatment options aiming to reduce limb volume or restore lymphatic flow may prove to be palliative or corrective. It is only through a strong team-based approach that such a continuum of care can exist, and a multidisciplinary approach to BCRL screening, intervention, and research is therefore strongly encouraged.

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“…An increasing body of clinical trials has confirmed a significantly lower incidence rate of BCRL in women undergoing ARM during ALND procedure compared with those receiving ALND alone (57)(58)(59). However, it is necessary to consider oncological safety when the arm nodes are conserved, particularly for patients with sentinel lymph node-positivity, as the co-localization of arm nodes and sentinel lymph nodes is as great as 27%, which is a key factor in metastasis (60). Fortunately, the risk of metastasis can be lowered if patients with sentinel lymph node receive neo-adjuvant chemotherapy (61).…”

Section: Preventionmentioning

confidence: 99%

Lymphedema in survivors of breast cancer (Review)

et al. 2020

Oncol Lett

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The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m 2 ), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.

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Feasibility study of axillary reverse mapping for patients with clinically node-negative breast cancer

Cited by 20 publications

References 30 publications

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

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

Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments

Lymphedema in survivors of breast cancer (Review)

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