Occurrence of breast‐cancer–related lymphedema after reverse lymphatic mapping and selective axillary dissection versus standard surgical treatment of axilla: A two‐arm randomized clinical trial

Abstract

Background:The need for axillary dissection (AD) is declining, but it is still essential for many patients with nodal involvement who risk developing breast-cancerrelated lymphedema (BCRL) with lifelong consequences. Previous nonrandomized studies found axillary reverse mapping and selective axillary dissection (ARM-SAD) a safe and feasible way to preserve the arm's lymphatic drainage. Methods:The present two-arm prospective randomized clinical trial was held at a single comprehensive cancer center to ascertain whether ARM-SAD can reduce the risk of BCRL, compared with standard AD, in patients with node-positive breast cancer. Whatever the type of breast surgery or adjuvant treatments planned, 130 patients with nodal involvement met our inclusion criteria: 65 were randomized for AD and 65 for ARM-SAD. Twelve months after surgery, a physiatrist assessed patients for BCRL and calculated the excess volume of the operated arm. Lymphoscintigraphy was used to assess drainage impairment. Self-reports of any impairment were also recorded. Results:The difference in the incidence of BCRL between the two groups was 21% (95% CI, 3-37; p = .03). A significantly lower rate of BCRL after ARM-SAD was confirmed by a multimodal analysis that included the physiatrist's findings, excess arm volume, and lymphoscintigraphic findings, but this was not matched by a significant difference in patients' self-reports. Conclusions:Our findings encourage a change of surgical approach when AD is still warranted. ARM-SAD may be an alternative to standard AD to reduce the treatment-related morbidity.

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

“…ARM was developed as a surgical procedure to minimize the risk of arm lymphedema by delineating and preserving arm-draining nodes and lymphatics during ALND [38,39]. Since the procedure first emerged, multiple randomized trials have confirmed that ARM is effective in reducing arm lymphedema [40][41][42][43][44][45]. However, there have also been concerns about the oncological safety of ARM due to the not-infrequent involvement of ARM nodes.…”

Breast Cancer Original article Axillary reverse mapping after neoadjuvant chemotherapy in clinically node-positive breast cancer patients

“…Axillary reverse mapping (ARM) has been developed as a procedure that delineates and preserves armdraining nodes and lymphatics during ALND, thereby minimizing arm lymphedema [5,6]. Initial studies suggested that ARM nodes do not harbor metastases originating from breast cancer [5,6], and several randomized studies demonstrated that ARM procedure is useful in reducing the occurrence of lymphedema [7,8,9,10,11]. However, there have been concerns reported in the literature that the preservation of ARM nodes may result in retained metastasis and inadequate oncological resection in cN + patients.…”

Axillary Reverse Mapping in Clinically Node-Positive Breast Cancer Patients

“…Axillary reverse mapping (ARM) has been developed as a procedure that delineates and preserves arm-draining nodes and lymphatics during ALND, thereby minimizing arm lymphedema [6,7]. Several randomized studies have demonstrated that the ARM procedure is useful in reducing the occurrence of lymphedema [8][9][10][11][12][13]. However, there have been concerns reported in the literature that the preservation of ARM nodes may result in retained metastasis and inadequate oncological resection in cN+ patients [14].…”