Axillary reverse mapping in the prevention of lymphoedema: a systematic review of randomized trials

Abstract

Goals:This is a systematic review of randomized controlled trials(RCT) comparing the use of axillary reverse mapping (ARM) withconventional technique for axillary dissection (AD) in breast cancersurgery. The primary objective is to compare the post-operativelymphoedema rate in the respective study and control groups.Secondary objectives focus on the oncological safety of axillaryreverse mapping quantified by intra-operative identification of ARMnodal metastasis and detection of axillary recurrence in thesubsequent follow up period.Methods:This review is written in line with the PRISMA protocol.Articles were retrieved from PubMed, EMBASE, CINAHL and Cochranedatabases, using keywords“axillary reverse mapping”and“axillarylymph node dissection.”Non-RCT were excluded. Abstracts werescreened independently by two reviewers. Data from eligible studieswere retrieved for qualitative synthesis and pooled analysis.Results:73 publications were identified for initial screening. 68articles were excluded from analysis according to the pre-definedsystematic review protocol. 5 RCTS with 1696 subjects were includedfor analysis. 802 patients received ARM, 894 patients received AD.Pooled ARM node detection rate was 84.9% (Range 79.2–94.9%).There was a lower rate of post-operative lymphoedema in ARM grouppatients across all 5 RCTs. The pooled lymphedema incidence in theARM group was 4.8% (37/766) when compared to 18.8% (164/873) inthe AD group (p < 0.0001). Pooled incidence of ARM lymph node metastasis was 5.7% (Range 0–8.5%). Axillary recurrence rate with median follow up of 37 monthswas 1.03% (8/778) in the ARM group, which was identical to 1.03% (9/870) in the AD group (p = 1).Conclusion(s):ARM resulted in decreased incidence of lymphedema.ARM node metastasis was identified in 5.7% of patients, however,there is no significant increase in axillary recurrence at 37 monthspost-operation.