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

Chao Han, Ben Yang, Wen-Shu Zuo, Gang Zheng, Li Yang, Mei-Zhu Zheng, Chao Han, Ben Yang, Wen-Shu Zuo, Gang Zheng, Li Yang, Mei-Zhu Zheng

Abstract

Objective: The 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.

Methods: We 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.

Results: A 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.

Conclusions: The 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. The selection process of included…
Fig 1. The selection process of included studies.
Fig 2. Forest plots of the pooled…
Fig 2. Forest plots of the pooled identification rate of ARM nodes or lymphatics, and crossover rate of ARM-SLN nodes during SLNB.
(A) the identification rate of ARM nodes or lymphatics; (B) the crossover rate of ARM-SLN nodes during SLNB.
Fig 3. Forest plot of the pooled…
Fig 3. Forest plot of the pooled identification rate of ARM nodes or lymphatics during ALND.
Fig 4. Forest plot of the pooled…
Fig 4. Forest plot of the pooled rate of metastasis in resected ARM nodes.
Fig 5. Forest plots of the association…
Fig 5. Forest plots of the association between preoperative neoadjuvant chemotherapy, axillary status and the risk of ARM metastasis.
(A) preoperative neoadjuvant chemotherapy; (B) axillary status.
Fig 6. Forest plot of the pooled…
Fig 6. Forest plot of the pooled incidence of lymphedema, which was stratified by different procedures.

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