Beek, M.A., Gobardhan, P.D., Schoenmaeckers, E.J., Klompenhouwer, E.G., Rutten, H.J., Voogd, A.C., & Luiten, E.J. (2016). Axillary reverse mapping in axillary surgery for breast cancer: An update of the current status. Breast Cancer Research and Treatment, 158, 421–432. 

STUDY PURPOSE: To review the evidence for axillary reverse mapping (ARM) and discuss the feasibility, safety, and relevance of this procedure

TYPE OF STUDY: General review/"semi" systematic

• FINAL NUMBER STUDIES INCLUDED = 31 
• TOTAL PATIENTS INCLUDED IN REVIEW = 2,747
• SAMPLE RANGE ACROSS STUDIES: 23–327
• KEY SAMPLE CHARACTERISTICS: All had breast cancer surgery involving ARM

PHASE OF CARE: Active antitumor treatment

Evidence shows a wide range of visualization rates from 20%–90% and notes that rates are lower with sentinel lymph node biopsy (SNLB) than with axillary lymph node dissection (ALND). The definition of successful ARM, the volume of blue dye used, and the experience of the surgeon varied, all of which may affect these rates. Blue dye, flourescent dye, and radioisotopes have been used for visualization. No adverse events from the procedures have been noted. At present, no axillary recurrence has been reported in patients in whom lymph nodes were preserved. ARM may contribute to a reduction in upper extremity lymphedema, although current evidence is not strong enough to draw firm conclusions.

The preservation of lymph nodes with ARM appears to be safe and may contribute to a reduction in the incidence of upper extremity lymphedema.

• No quality evaluation
• Most studies had a relatively short follow-up time frame.

The preservation of axillary lymph nodes in women undergoing surgery for breast cancer with ARM appears to be safe. The evidence suggests that ARM with lymph node preservation may reduce the prevalence of arm lymphedema; however, multiple limitations in the available evidence exist. Ongoing research of the long-term effects on patient outcomes is needed and underway.