Axillary reverse lymphatic mapping reduces patient perceived incidence of lymphedema after axillary dissection in breast cancer

Pasko, Jennifer; Garreau, Jennifer R.; Carl, Amy; Ansteth, Mindy; Glissmeyer, Margaret; Johnson, Nathalie

doi:10.1016/j.amjsurg.2015.01.011

Cited by 17 publications

(9 citation statements)

References 18 publications

(5 reference statements)

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“…Twenty-eight studies were included into qualitative synthesis. Subsequently, one retrospective study and three studies with overlapping population were discarded [ 3 , 10 , 23 , 24 ]. The remaining 24 publications were pooled into meta-analysis, involving 2709 patients [ 5 – 9 , 11 , 25 – 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Currently, axillary lymph node dissection (ALND) represents the standard treatment for patients with metastatic axillary lymph nodes [ 1 ]. However, ALND always carries an unacceptable high incidence of lymphedema, ranging from 6% to 57% [ 3 ]. For patients with clinically negative axilla, Sentinel lymph nodes biopsy (SLNB) is recommended for the surgical staging, with significantly decreased surgical complications compared with ALND [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

et al. 2016

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ObjectiveThe axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving the arm lymphatic drainage during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) procedures. The objective of this systematic review and meta-analysis was to evaluate the feasibility and oncological safety of ARM.MethodsWe searched Medline, Embase, Web of science, Scopus, and the Cochrane Library for relevant prospective studies. The identification rate of ARM nodes, the crossover rate of SLN-ARM nodes, the proportion of metastatic ARM nodes, and the incidence of complications were pooled into meta-analyses by the random-effects model.ResultsA total of 24 prospective studies were included into meta-analyses, of which 11 studies reported ARM during SLNB, and 18 studies reported ARM during SLNB. The overall identification rate of ARM nodes was 38.2% (95% CI 32.9%-43.8%) during SLNB and 82.8% (78.0%-86.6%) during ALND, respectively. The crossover rate of SLN-ARM nodes was 19.6% (95% CI 14.4%-26.1%). The metastatic rate of ARM nodes was 16.9% (95% CI 14.2%-20.1%). The pooled incidence of lymphedema was 4.1% (95% CI 2.9–5.9%) for patients undergoing ARM procedure.ConclusionsThe ARM procedure was feasible during ALND. Nevertheless, it was restricted by low identification rate of ARM nodes during SLNB. ARM was beneficial for preventing lymphedema. However, this technique should be performed with caution given the possibility of crossover SLN-ARM nodes and metastatic ARM nodes. ARM appeared to be unsuitable for patients with clinically positive breast cancer due to oncological safety concern.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

et al. 2016

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“…This technique is underpinned by the assumption that the lymphatic drainage of the arm and breast are separate in the axillary region but are anatomically interconnected (56). 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).…”

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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“…Der freie VLKT gilt als das invasivere Verfahren der rekonstruktiven Techniken mit dem Risiko eines Hebedefektlymphödems. Daher wird ein "reverse mapping" der Entnahmeregion zur Reduktion von Spendermorbidität (iatrogenes Lymphödem) als obligat betrachtet [46,47]. Insbesondere bei der Entnahme von Leistenlymphknoten oder Axilla-nahen Lymphknoten besteht ein Risiko für die Entwicklung eines Hebedefektlymphödems, das in einer Meta-Analyse von Demiri et al unter Einschluss von 11 Studien und 189 Patienten mit drei publizierten Ereignissen mit 1,6 % auftrat [48].…”

Section: Mögliche Entnahmeregionenunclassified

Rekonstruktive Mikrochirurgie des sekundären Lymphödems: Konsensus der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) zur Indikation, Diagnostik und Therapie mittels Lymphovenöser Anastomosen (LVA) und vaskularisierter Lymphknotentransplantation (VLKT)

Hirche

Engel

Seidenstuecker

et al. 2019

Handchir Mikrochir plast Chir

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ZusammenfassungDas sekundäre Lymphödem ist eine komplexe Erkrankung, die durch chronische Inflammation und reduzierte Immunkompetenz, Ansammlung von Lymphflüssigkeit und Proteinablagerungen sowie sekundärer Fettablagerung und Fibrosierung bei der Stadienmigration charakterisiert ist. Während die Domäne der Behandlung immer noch eine lebenslange komplexe physikalische Entstauungstherapie (KPE) ist, wird der Fokus auf chirurgische Verfahren zur physiologischen Rekonstruktion gesetzt. Die lymphovenösen Anastomosen (LVA) und die freie, vaskularisierte Lymphknotentransplantation (VLKT) sind die am verbreitetsten angewendeten, rekonstruktiven Techniken, die die Wiederherstellung oder Verbesserung der physiologischen Lymphtransportkapzität adressieren. Der vorliegende Artikel fasst die Empfehlungen eines Expertenpanels zur Diagnostik, Indikation und Therapie von LVA und VLKT bei sekundären Lymphödemen während der 40. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) in Lugano, Schweiz, zusammen und diskutiert sie. Das Expertengremium befasste sich mit der Diagnostik für die lymphorekonstruktive Chirurgie, einschließlich der essentiellen Anwendung der Fluoreszenz-Lymphangiographie mit Indocyaningrün (ICG) und der intraoperativen Navigation für beide Techniken sowie dem „reverse mapping“, um die Rate des Hebestellen-Lymphödems nach VLKT zu reduzieren, sowie die Verwendung von Lymphödem-spezifischen Fragebögen zur Lebensqualität. Sowohl LVA als auch VLKT werden einschließlich Tipps und Tricks zur Identifizierung funktioneller Lymphkollektoren, Ausrüstung, Anastomosenarten und Dokumentation für LVA sowie Auswahl der Spender- und Empfängerstelle, Anzahl der inkludierten Lymphknoten und Herangehensweise an spezifische Spenderstellen, wie z. B. jejunal-mesenterial für den VLKT, beschrieben. Die synchrone und sequentielle Anwendung von LVA, VLKT und/oder ablativer Liposuktion wird vor dem Hintergrund der Wirksamkeit und Morbidität diskutiert. Schließlich werden Empfehlungen zur postoperativen Behandlung und Diagnostik erörtert. Die vorliegende Konsensusarbeit adressiert eine Erhöhung des Standardisierungsgrades der Behandlung für weitere multizentrische Studien im deutschsprachigen Raum in diesem aufstrebenden Gebiet der Lymphödemtherapie.

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Axillary reverse lymphatic mapping reduces patient perceived incidence of lymphedema after axillary dissection in breast cancer

Cited by 17 publications

References 18 publications

The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

Lymphedema in survivors of breast cancer (Review)

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