Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis. (October 2020)

• Record Type: Journal Article
• Authors: Wijaya, Wilson A.; Peng, Jing; He, Yinhai; Chen, Junjie; Cen, Ying
• Is Part Of: Breast. Volume 53(2020)
• Page Start: 189
• Page End: 200
• Publication Date: 2020-10
• Subjects: Breast cancer -- Axillary reverse mapping -- Lymphedema -- Meta-analysis; ARM axillary reverse mapping -- SNL sentinel lymph node -- SLNB sentinel lymph node biopsy -- ALND axillary lymph node dissection -- BCRL breast cancer-related lymphedema -- AHRQ Agency for Healthcare Research and Quality -- NAC neoadjuvant chemotherapy -- CI confidence interval -- OR odds ratio; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2020.08.007
• Languages: English
• ISSNs: 0960-9776

Abstract

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. Highlights: ARM is a simple and feasible technique that effectively reduces the incidence of BCRL. Performing ARM technique for breast cancer patients should be considered carefully on account of its oncological safety. Preoperative NAC is not correlated with less metastatic involvement in the ARM lymph nodes.